Priority accuracy by dispatch centers and Emergency Medical Services professionals in trauma patients: a cohort study

Abstract

Purpose Priority-setting by dispatch centers and Emergency Medical Services professionals has a major impact on pre-hospital triage and times of trauma patients. Patients requiring specialized care benefit from expedited transport to higher-level trauma centers, while transportation of these patients to lower-level trauma centers is associated with higher mortality rates. This study aims to evaluate the accuracy of priority-setting by dispatch centers and Emergency Medical Services professionals. Methods This observational study included trauma patients transported from the scene of injury to a trauma center. Priority-setting was evaluated in terms of the proportion of patients requiring specialized trauma care assigned with the highest priority (i.e., sensitivity), undertriage, and overtriage. Patients in need of specialized care were defined by a composite resource-based endpoint. An Injury Severity Score ≥ 16 served as a secondary reference standard. Results Between January 2015 and December 2017, records of 114,459 trauma patients were collected, of which 3327 (2.9%) patients were in need of specialized care according to the primary reference standard. Dispatch centers and Emergency Medical Services professionals assigned 83.8% and 74.5% of these patients with the highest priority, respectively. Undertriage rates ranged between 22.7 and 65.5% in the different prioritization subgroups. There were differences between dispatch and transport priorities in 17.7% of the patients. Conclusion The majority of patients that required specialized care were assigned with the highest priority by the dispatch centers and Emergency Medical Services professionals. Highly accurate priority criteria could improve the quality of pre-hospital triage.

Accuracy of Prehospital Triage of Adult Patients With Traumatic Injuries Following Implementation of a Trauma Triage Intervention

“… 17 , 18 Confounders were chosen based on clinical reasoning and previous literature. 8 , 11 , 19 , 20 , 21 Risks and odds were adjusted for age, sex, dispatch priority, day of the week, hour of the day, distance to the nearest higher-level trauma center, penetrating injury, hemodynamic instability (ie, compromised airway, breathing, or circulation), prehospital vital signs (systolic blood pressure, respiratory rate, Glasgow Coma Scale score, heart rate, and oxygen saturation), and ISS. Restricted cubic splines with 3 knots were used to account for nonlinearity.…”

Enhancing the detection of out-of-hospital cardiac arrest: a study of emergency medical system in Thailand

“…[3][4][5] In Thailand, guidelines for providing DA-CPR, so-called 'Criteria based dispatch and prioritizing emergency patient care' were outlined by the National Institute of Emergency Medical Service Thailand in 2013. 6 These guidelines include specific inquiries for all emergency cases, including the symptoms, location, phone number, caller's name, and consciousness of the patient. If a patient is unconscious and not breathing or has agonal breathing, the case will be identified as OHCA and coded 6 red 1, after which CPR instructions are provided over the phone.…”