Prehospital identification of major trauma patients

Abstract

Prehospital triage is aimed at getting the right patient to the right hospital. Evaluations on the performance of prehospital triage tools are scarce. This study examines the ability of the American College of Surgeons' Committee on Trauma (ACSCOT) triage guidelines to identify major trauma patients in a European trauma system. Furthermore, this study evaluates the predictive power of other prehospital measurements. Prehospital data of 151 minor (Injury Severity Score (ISS) 1-15) and 151 major trauma patients, (ISS > 15) treated at a Dutch trauma center, were collected. Logistic regression analysis was used to identify predictors of major trauma patients. The major trauma patients particularly incurred severe head injuries (45.7%) and severe thorax injuries (21.9%). The ACSCOT guidelines had a sensitivity of 84.1% and a specificity of 77.5%. A new prehospital trauma triage model was constructed including nine predictors of major trauma. This model identified more major trauma patients than the ACSCOT (sensitivity 92.1%, p = 0.023) and resulted in a comparable specificity (79.5%; p = 0.711). The new triage model outperforms the ACSCOT triage guidelines in identifying major trauma patients in the prehospital setting. The new triage guidelines may improve patient outcomes but needs to be validated in a prospective study.