A regional trauma system to optimize the pre-hospital triage of trauma patients.

Details

Serval ID
serval:BIB_35ABE32FB021
Type
Article: article from journal or magazin.
Collection
Publications
Institution
Title
A regional trauma system to optimize the pre-hospital triage of trauma patients.
Journal
Critical care
Author(s)
Bouzat P., Ageron F.X. (co-first), Brun J., Levrat A., Berthet M., Rancurel E., Thouret J.M., Thony F., Arvieux C., Payen J.F.
Working group(s)
TRENAU group
Contributor(s)
Albasini F., Champly F., Danel V., Debaty G., Grailles F., Habold D., Hoareau C., Peribois G., Savary D., Vallenet C.
ISSN
1466-609X (Electronic)
ISSN-L
1364-8535
Publication state
Published
Issued date
18/03/2015
Peer-reviewed
Oui
Volume
19
Pages
111
Language
english
Notes
Publication types: Journal Article
Publication Status: epublish
Abstract
Pre-hospital triage is a key element in a trauma system that aims to admit patients to the most suitable trauma center, and may decrease intra-hospital mortality. We evaluated the performance of a pre-hospital procedure in a regional trauma system through measurements of the quality of pre-hospital medical assessment and the efficacy of a triage protocol.
Our regional trauma system included 13 hospitals categorized as Level I, II or III trauma centers according to their technical facilities. Each patient was graded A, B or C by an emergency physician, according to the seriousness of their injuries at presentation on scene. The triage was performed according to this grading and the categorization of centers. This study is a registry analysis of a three-year period (2009 to 2011).
Of the 3,428 studied patients, 2,572 were graded using the pre-hospital grading system (Graded group). The pre-hospital gradation was closely related with injury severity score (ISS) and intra-hospital mortality rate. The triage protocol had a sensitivity of 92% (95% confidence interval (CI) 90% to 93%) and a specificity of 41% (95% CI 39% to 44%) to predict adequate admission of patients with ISS more than 15. A total of 856 patients were not graded at the scene (Non-graded group). Undertriage rate was significantly reduced in the Graded group compared with the Non-graded group, with a relative risk of 0.47 (95% CI 0.40 to 0.56) according to the definition of the American College of Surgeons Committee on Trauma (P <0.001). Where adjusted for trauma severity, the expected mortality rate at discharge from hospital was higher than observed mortality, with a difference of +2.0% (95% CI 1.4 to 2.6%; P <0.01).
Implementation of a regional trauma system with a pre-hospital triage procedure was effective in detecting severe trauma patients and in lowering the rate of pre-hospital undertriage. A beneficial effect on outcome of such an organization is suggested.
Keywords
Adult, Emergency Medical Services, Female, France/epidemiology, Humans, Injury Severity Score, Male, Registries, Sensitivity and Specificity, Trauma Centers, Triage/methods, Wounds and Injuries/mortality
Pubmed
Web of science
Open Access
Yes
Create date
09/03/2021 12:32
Last modification date
02/03/2022 7:35
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