Abstract 374: Modified Physiologic Criteria for the Field Triage Scheme: Efficacy of Major Trauma Recognition in Different Age Groups Across Asia

Abstract

Introduction: Identifying patients with major trauma in prehospital settings by Field Triage Scheme (FTS) is of paramount importance. The goal of the FTS was set with a sensitivity (Sn) of 95% and specificity (Sp) of 50% to identify patients with major trauma, although many studies showed it unachievable. A simplified FTS (sFTS) may offer a more rapid prehospital triage of patients. However, evidence of its accuracy remains unclear. Hypothesis: We examined the performance of identifying patients with major trauma by triage tools of sFTS, modified sFTS, and adding shock index (SI) in different age groups. Methods: We conducted a multinational retrospective cohort study involving a total of 51,622 adult trauma patients in the studied countries from 2016 to 2020, using data from the Pan-Asia Trauma Outcomes Study. We tested (1) sFTS comprising only physiological and anatomical criteria, (2) modified sFTS defined by fine-tuning the physiological criteria of GCS score < 15, respiratory rate <10 or ≥ 24 beats/minute, and systolic blood pressure < 110 mmHg, and (3) sequentially added a SI of ≧0.8, to compare their performance in identifying patients with major trauma. Major trauma was defined by injury severity score ≥ 16. The cubic-spline method was used to smooth the curves of Sn/Sp across ages. Results: The overall sensitivity and specificity of the sFTS, modified sFTS, and adding SI of 0.8 to modified sFTS were, 80.6%, 82.8%, 84.3%, and 58.5%, 53.7%, 49.2%, respectively. The trade-off of Sn/Sp was illustrated in Figure 1. The top Sn/Sp of the three triage tools was constantly at patients’ age of 50, with rapidly declining in both younger and older patients. The modified sFTS showed increasing sensitivity with more pronounced changes in the younger group. Adding the shock index further increased sensitivity in both younger and older groups.