The impact of the Trauma Triage App on pre-hospital trauma triage: design and protocol of the stepped-wedge, cluster-randomized TESLA trial

Rogier Van Der Sluijs,Dennis Den Hartog,W Margreet Hoogeveen,Luke P H Leenen,Mark Van Heijl,J Carel Goslings,Johannes B Reitsma,Silvia M A A Evers,Audrey A A Fiddelers,Job F Waalwijk,Koen W Lansink,Martijn Poeze,Miranda J Dirx

doi:10.1186/s41512-020-00076-1

Abstract

BackgroundField triage of trauma patients is crucial to get the right patient to the right hospital within a particular time frame. Minimization of undertriage, overtriage, and interhospital transfer rates could substantially reduce mortality rates, life-long disabilities, and costs. Identification of patients in need of specialized trauma care is predominantly based on the judgment of Emergency Medical Services professionals and a pre-hospital triage protocol. The Trauma Triage App is a smartphone application that includes a prediction model to aid Emergency Medical Services professionals in the identification of patients in need of specialized trauma care. The aim of this trial is to assess the impact of this new digital approach to field triage on the primary endpoint undertriage.MethodsThe Trauma triage using Supervised Learning Algorithms (TESLA) trial is a stepped-wedge cluster-randomized controlled trial with eight clusters defined as Emergency Medical Services regions. These clusters are an integral part of five inclusive trauma regions. Injured patients, evaluated on-scene by an Emergency Medical Services professional, suspected of moderate to severe injuries, will be assessed for eligibility. This unidirectional crossover trial will start with a baseline period in which the default pre-hospital triage protocol is used, after which all clusters gradually implement the Trauma Triage App as an add-on to the existing triage protocol. The primary endpoint is undertriage on patient and cluster level and is defined as the transportation of a severely injured patient (Injury Severity Score ≥ 16) to a lower-level trauma center. Secondary endpoints include overtriage, hospital resource use, and a cost-utility analysis.DiscussionThe TESLA trial will assess the impact of the Trauma Triage App in clinical practice. This novel approach to field triage will give new and previously undiscovered insights into several isolated components of the diagnostic strategy to get the right trauma patient to the right hospital. The stepped-wedge design allows for within and between cluster comparisons.Trial registrationNetherlands Trial Register, NTR7243. Registered 30 May 2018, https://www.trialregister.nl/trial/7038.

Highlights

Field triage of trauma patients is crucial to get the right patient to the right hospital within a particular time frame
Getting the right patient to the right hospital within a certain time frame is becoming increasingly important with the maturation of trauma systems and centralization of resources
Costs and mortality rates can be reduced by minimizing undertriage, overtriage, and interhospital transfer rates

Summary

Introduction

Field triage of trauma patients is crucial to get the right patient to the right hospital within a particular time frame. The Trauma Triage App is a smartphone application that includes a prediction model to aid Emergency Medical Services professionals in the identification of patients in need of specialized trauma care. The aim of this trial is to assess the impact of this new digital approach to field triage on the primary endpoint undertriage. Transporting a patient not in need of specialized trauma care to a higher-level trauma center results in extra costs and overutilization of resources [3] These key metrics to evaluate the quality of field triage in trauma systems are termed undertriage and overtriage, respectively [1]. The mean undertriage across all inclusive trauma regions in the Netherlands was 31.4% in 2016 [5]

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