Field Triage Research Articles

Accuracy of the Quebec Pre-Hospital Triage Scale (EQTPT) in Predicting the Need for Trauma Team Activation: A Retrospective Administrative Data Study

Background: Trauma team activation at a Level 1 trauma centre In Quebec, Canada, is primarily at the emergency department’s staff discretion. Trauma teams may be activated prehospital, based on information provided by field paramedics or in the emergency department based on the patient’s condition on arrival. In this study, we examined over and undertriage rates based on present trauma team activation criteria. We also examined if trauma team activation, for those patients solely meeting pre-hospital major trauma criteria, would result in significant overactivation of the trauma team. Methods: This is a single-centre retrospective medical record review. Primary ambulance transport reports from May 15, 2018 to December 31, 2020, were screened to identify patients aged ≥16 years who met pre-hospital trauma triage criteria to bypass community hospitals to arrive directly at the Level 1 trauma centre. We examined pre-hospital triage criteria, trauma team involvement, Injury Severity Scores (ISS) and final disposition. Patients were evaluated for over and undertriage and rates were compared to the rates assuming all patients were to have a trauma team activation. We considered patients overtriaged if they had a full trauma team activation but had an ISS <12 and were discharged from the emergency department. Undertriage was defined as any patient with an ISS ³12 and did not have a trauma team activation. Results: Of the 371 patients who met study inclusion criteria, 123 (33.3%) did not meet trauma team activation criteria, while 214 (57.7%) had a trauma team activation. Of these, 49 patients (13.2%) were undertriaged and 31 patients (8.4%) were overtriaged and 25.8% of the major trauma patients (ISS ³ 12) were undertriaged. A trauma team activation for all meeting field triage criteria increased overtriage to 25.3% and brought undertriage rates to 0%, with statistically significant differences based on the Wilcoxon signed ranks test (p<0.05). Conclusions: In this study, undertriage rates were well above 5%. Trauma team activation, based on local field trauma triage criteria adapted from the CDC-ACSCOT field triage criteria, eliminates undertriage and keeps overtriage rates below 35%. This research suggests that field triage criteria accurately predict major trauma and the need for the involvement of the trauma team and that the condition of the trauma patient in the pre-hospital setting is accurately predicting the need for advanced trauma care

Enhancing Performance of the National Field Triage Guidelines Using Machine Learning: Development of a Prehospital Triage Model to Predict Severe Trauma.

Prehospital trauma triage is essential to get the right patient to the right hospital. However, the national field triage guidelines proposed by the American College of Surgeons have proven to be relatively insensitive when identifying severe traumas. This study aimed to build a prehospital triage model to predict severe trauma and enhance the performance of the national field triage guidelines. This was a multisite prediction study, and the data were extracted from the National Trauma Data Bank between 2017 and 2019. All patients with injury, aged 16 years of age or older, and transported by ambulance from the injury scene to any trauma center were potentially eligible. The data were divided into training, internal, and external validation sets of 672,309; 288,134; and 508,703 patients, respectively. As the national field triage guidelines recommended, age, 7 vital signs, and 8 injury patterns at the prehospital stage were included as candidate variables for model development. Outcomes were severe trauma with an Injured Severity Score ≥16 (primary) and critical resource use within 24 hours of emergency department arrival (secondary). The triage model was developed using an extreme gradient boosting model and Shapley additive explanation analysis. The model's accuracy regarding discrimination, calibration, and clinical benefit was assessed. At a fixed specificity of 0.5, the model showed a sensitivity of 0.799 (95% CI 0.797-0.801), an undertriage rate of 0.080 (95% CI 0.079-0.081), and an overtriage rate of 0.743 (95% CI 0.742-0.743) for predicting severe trauma. The model showed a sensitivity of 0.774 (95% CI 0.772-0.776), an undertriage rate of 0.158 (95% CI 0.157-0.159), and an overtriage rate of 0.609 (95% CI 0.608-0.609) when predicting critical resource use, fixed at 0.5 specificity. The triage model's areas under the curve were 0.755 (95% CI 0.753-0.757) for severe trauma prediction and 0.736 (95% CI 0.734-0.737) for critical resource use prediction. The triage model's performance was better than those of the Glasgow Coma Score, Prehospital Index, revised trauma score, and the 2011 national field triage guidelines RED criteria. The model's performance was consistent in the 2 validation sets. The prehospital triage model is promising for predicting severe trauma and achieving an undertriage rate of <10%. Moreover, machine learning enhances the performance of field triage guidelines.

Exploring patient and system factors impacting undertriage of injured patients meeting national field triage guideline criteria.

Trauma systems save lives by coordinating timely and effective responses to injury. However, trauma system effectiveness varies geographically, with worse outcomes observed in rural settings. Prior data suggest that undertriage may play a role in this disparity. Our aim was to explore potential driving factors for decision making among clinicians for undertriaged trauma patients. We performed a retrospective analysis of the National Emergency Medical Services Information System database among patients who met physiologic or anatomic national field triage guideline criteria for transport to the highest level of trauma center. Undertriage was defined as transport to a non-level I/II trauma center. Multivariable logistic regression was used to determine demographic, injury, and system characteristics associated with undertriage. Undertriaged patients were then categorized into "recognized" and "unrecognized" groups using the documented reason for transport destination to identify underlying factors associated with undertriage. A total of 36,094 patients were analyzed. Patients in urban areas were more likely to be transported to a destination based on protocol rather than the closest available facility. As expected, patients injured in urban regions were less likely to be undertriaged than their suburban (adjusted odds ratio [aOR], 2.69; 95% confidence interval [95% CI], 2.21-3.31), rural (aOR, 2.71; 95% CI, 2.28-3.21), and wilderness counterparts (aOR, 3.99; 95% CI, 2.93-5.45). The strongest predictor of undertriage was patient/family choice (aOR, 6.29; 5.28-7.50), followed by closest facility (aOR, 5.49; 95% CI, 4.91-6.13) as the reason for hospital selection. Nonurban settings had over twice the odds of recognizing the presence of triage criteria among undertriaged patients (p < 0.05). Patients with injuries in nonurban settings and those with less apparent causes of severe injury are more likely to experience undertriage. By analyzing how prehospital clinicians choose transport destinations, we identified patient and system factors associated with undertriage. Targeting these at-risk demographics and contributing factors may help alleviate regional disparities in undertriage. Diagnostic; Level IV.

Validation of motor component of Glasgow coma scale in lieu of total Glasgow coma scale as a pediatric trauma field triage tool

IntroductionPrehospital trauma triage and disability assessment of pediatric patients can be challenging on the field, especially in the pre-verbal age group. It would be useful if the same triage tool and criteria can be used for both adults and children to risk-stratify the need of higher acuity of trauma care. Study objectiveWe aimed to investigate if using only the motor component of Glasgow Coma Scale (mGCS), as a quick field trauma triage tool, was non-inferior to total GCS (tGCS), and if mGCS <6 was non-inferior to tGCS <14, in predicting the need for intensive care or mortality in the pediatric population. MethodsWe performed a retrospective review of patients <18-years-old, who presented to our emergency department (ED) with moderate (Injury Severity Score (ISS) 9–15) to severe (ISS > 15) traumatic injuries from January 2012 to December 2021. Using ED triage data, mortality and the need for intensive care unit (ICU) admission were used as surrogate outcomes to investigate if mGCS <6 was non-inferior to tGCS <14, and the area-under-the-receiver-operating-characteristic curve (AUROC) was used as a measure of comparability. ResultsAmong 582 included for analysis, the median age was 7-years-old (2–12), and most were male (63.4%). 22.4% patients demised or required ICU care. mGCS <6 had an AUROC of 0.75 (95% CI 0.70 to 0.79), which was non-inferior to tGCS <14; AUROC 0.76, (95% CI 0.72 to 0.81), for identifying children requiring ICU management or demised. The results shown here were based on the AUROCs that were used to evaluate the discriminatory ability of tGCS <14 and mGCS <6 in prediction of mortality and the need for ICU care. ConclusionOur study showed that mGCS was significantly associated with tGCS, and was non- inferior to the latter as a triage tool in pediatric trauma. It validated the use of mGCS <6 in lieu of tGCS <14 in the pre-hospital field triage of pediatric patients, in identification of children at risk of death or requiring ICU care. Larger prospective, observational studies using on-scene data would be required for more robust validation and determine optimal cut-offs.

English

Background: For patients sustaining major trauma, decreasing time to definitive care remains a primary goal. Specialized trauma team involvement is essential for coordinating the emergency department care of complex major trauma patients. The aim of this study was to evaluate if the timing of trauma team involvement impacts length of stay and time to definitive care in the emergency department. Methods: This is a single-centre retrospective medical record review, including patients meeting Quebec pre-hospital triage criteria for major trauma from May 15, 2018 to December 31, 2020. We assessed time from patient arrival until departure from the resuscitation room, time to CT scan, time to disposition, and overall length of emergency department stay. Patients were grouped according to the timing of trauma team activation (TTA) as (1) pre-hospital notification, (2) on arrival in the emergency department, (3) receiving a trauma consult only, or (4) no trauma team involvement. Mean times and standard deviations were calculated, and group differences were assessed using the Kruskal-Wallis test and the independent sample Mann-Whitney U test. Results: We identified 371 patients meeting our inclusion criteria; there were no differences between groups in mean time spent in the resuscitation room based on the timing of trauma team involvement (45-51 minutes, p=0.422). A trauma team activation with pre-hospital notification was associated with a statistically significant shorter time to CT scan (62-81 minutes, p=0.010), time to disposition (6:37-13:41, p&lt;0.001), and total emergency department length of stay (9:22-23:16 hours: minutes, p&lt;0.001). Conclusion: Appropriate trauma team activation improves performance indicators used to evaluate the quality of care in the emergency department. This research suggests that pre-hospital trauma team activation should be considered the standard of care for all patients meeting pre-hospital field triage criteria for major trauma. Keywords: trauma, triage, pre-hospital, trauma team activation, trauma quality indicators

Field Triage Tools in Mass Casualty Incidents: A Narrative Review

Mass casualty incidents (MCIs) pose significant challenges to healthcare systems, requiring rapid and effective triage strategies to optimize patient outcomes and resource utilization. This narrative review explores the evolution, effectiveness, ethical considerations, global perspectives, and future directions of field triage tools in MCIs. Beginning with the historical perspective, milestones in triage development, such as the Simple Triage and Rapid Treatment (START) protocol and its adaptations like Jump START and Sort, Assess, Lifesaving Interventions, Treat/Transport (SALT), are discussed. Current field triage systems are evaluated, including their application, limitations, and impact on patient outcomes. Training and education programs, challenges in triage education, and ethical/legal considerations in resource allocation and informed consent are examined. Global variations in triage systems, cultural factors, collaboration efforts, and standardization initiatives are explored to understand regional differences and promote interoperability. Future directions emphasize enhancing triage accuracy, integrating triage with healthcare systems, and research priorities. The review concludes with implications for practice and policy, calling for continued research, collaboration, and innovation to advance field triage capabilities and improve emergency response worldwide.

Proof of principle: An animal field triage protocol for livestock and horses caught in natural disasters and major incidents

Field triage systems are available to address mass casualty incidents involving humans, but lack for animals caught in disasters. This study aimed to develop, as a proof of principle, an animal field triage protocol for livestock, horses and wildlife based on an existing human triage system. A literature review was completed, resulting in choosing the human SALT triage algorithm as a starting point, followed by an expert consultation using a two-round Delphi study to evaluate and create the final version of the triage protocol. Finally, a group of first responders were familiarized with the protocol and triage injured animals in a simulated disaster environment using a purpose-built training game and provide written feedback. For livestock and horses, consensus was reached on the use of global sorting based on the criteria ‘autonomously mobile without obvious major injuries’, and on five of six appropriate physiological criteria applied for individual health state assessment. Triaged animals were placed in one of four categories developed for applicable veterinary care, being beyond saving (black), immediate/urgent (red), delayed (yellow) and minor (green). The expert panel agreed that the veterinary triage model is probably workable for livestock and horses but not for wildlife, and has added value in natural disasters and mass casualty incidents involving animals. Validation of the protocol with first responders on the usability of the triage protocol as a proof of principle warrants a careful introduction for practical use and further evaluation during disasters affecting livestock and horses in the field.

Evaluation of Prehospital Undertriage in Relation to Trauma Team Activation-Results from a Prospective Study in 12 Level one German Trauma Centers.

Background/Objective: This prospective, multicenter observational cohort study was carried out in 12 trauma centers in Germany and Switzerland. Its purpose was to evaluate the rate of undertriage, as well as potential consequences, and relate these with different Trauma Team Activation Protocols (TTA-Protocols), as this has not been done before in Germany. Methods: Each trauma center collected the data during a three-month period between December 2019 and February 2021. All 12 participating hospitals are certified as supra-regional trauma centers. Here, we report a subgroup analysis of undertriaged patients. Those included in the study were all consecutive adult patients (age ≥ 18 years) with acute trauma admitted to the emergency department of one of the participating hospitals by the prehospital emergency medical service (EMS) within 6 h after trauma. The data contained information on age, sex, trauma mechanism, pre- and in-hospital physiology, emergency interventions, emergency surgical interventions, intensive care unit (ICU) stay, and death within 48 h. Trauma team activation (TTA) was initiated by the emergency medical services. This should follow the national guidelines for severe trauma using established field triage criteria. We used various denominators, such as ISS, and criteria for the appropriateness of TTA to evaluate the undertriage in four groups. Results: This study included a total of 3754 patients. The average injury severity score was 5.1 points, and 7.0% of cases (n = 261) presented with an injury severity score (ISS) of 16+. TTA was initiated for a total of 974 (26%) patients. In group 1, we evaluated how successful the actual practice in the EMS was in identifying patients with ISS 16+. The undertriage rate was 15.3%, but mortality was lower in the undertriage cohort compared to those with a TTA (5% vs. 10%). In group 2, we evaluated the actual practice of EMS in terms of identifying patients meeting the appropriateness of TTA criteria; this showed a higher undertriage rate of 35.9%, but as seen in group 1, the mortality was lower (5.9% vs. 3.3%). In group 3, we showed that, if the EMS were to strictly follow guideline criteria, the rate of undertriage would be even higher (26.2%) regarding ISS 16+. Using the appropriateness of TTA criteria to define the gold standard for TTA (group 4), 764 cases (20.4%) fulfilled at least one condition for retrospective definition of TTA requirement. Conclusions: Regarding ISS 16+, the rate of undertriage in actual practice was 15.3%, but those patients did not have a higher mortality.

Medical Records in Field Operations: A No-Code Approach

Abstract Commercial Electronic Health Record (EHR) systems in the U.S. are hospital-centric and are optimized for billing and insurance processes and liability risk management. Operational medicine has completely different medical record requirements, with dynamic and unpredictable environments and a focus on field triage, emergent patient needs, logistical coordination, and ultimately, the efficient transfer of care. The DHS Office of Health Security’s Medical Information Exchange (MIX) and the DHA’s Joint Operational Medicine Information Systems (JOMIS) programs have been exploring EHR solutions which anticipate and support the multilateral collaborations and fluid circumstances of field-based medical care using a no-code (drag and drop) solution that can be tailored to requirements in real time, can scale down to mobile devices, and can retain full functionality even while offline.

Fusion of Forensic Analysis of Mobile Devices: Integrating Multi-Criteria Decision Methods and Case Study Insights

This study employed a Multi-Criteria Decision Analysis (MCDM) approach, utilizing the DEMATEL and TOPSIS methodologies, to assess the effectiveness of forensic tools designed for mobile devices, with a specific emphasis on Android and iOS platforms. The investigation evaluated technologies used for collecting, retrieving, and validating data in the Cyber Forensic Field Triage paradigm, with a focus on rapidly identifying and interpreting digital evidence. The study incorporated several factors and expert preferences, concluding that the Android Triage and Andriller tools were the most efficient.

Modified physiologic criteria for the field triage scheme: Efficacy of major trauma recognition in different age groups in Asia

BackgroundMajor trauma is a leading cause of unexpected death globally, with increasing age-adjusted death rates for unintentional injuries. Field triage schemes (FTSs) assist emergency medical technicians in identifying appropriate medical care facilities for patients. While full FTSs may improve sensitivity, step-by-step field triage is time-consuming. A simplified FTS (sFTS) that uses only physiological and anatomical criteria may offer a more rapid decision-making process. However, evidence for this approach is limited, and its performance in identifying all age groups requiring trauma center resources in Asia remains unclear. MethodsWe conducted a multinational retrospective cohort study involving adult trauma patients admitted to emergency departments in the included countries from 2016 to 2020. Prehospital and hospital data were reviewed from the Pan-Asia Trauma Outcomes Study database. Patients aged ≥18 years transported by emergency medical services were included. Patients lacking data regarding age, sex, physiological criteria, or injury severity scores were excluded. We examined the performance of sFTS in all age groups and fine-tuned physiological criteria to improve sFTS performance in identifying high-risk trauma patients in different age groups. ResultsThe sensitivity and specificity of the physiological and anatomical criteria for identifying major trauma (injury severity score ≥ 16) were 80.6% and 58.8%, respectively. The modified sFTS showed increased sensitivity and decreased specificity, with more pronounced changes in the young age group. Adding the shock index further increased sensitivity in both age groups. ConclusionssFTS using only physiological and anatomical criteria is suboptimal for Asian adult patients with trauma of all age groups. Adjusting the physiological criteria and adding a shock index as a triage tool can improve the sensitivity of severely injured patients, particularly in young age groups. A swift field triage process can maintain acceptable sensitivity and specificity in severely injured patients.

Characterizing re-triage guidelines: A scoping review of states’ rules and regulations

BackgroundState guidelines for re-triage, or emergency inter-facility transfer, have never been characterized across the United States. MethodsAll 50 states’ Department of Health and/or Trauma System websites were reviewed for publicly available re-triage guidelines within their rules and regulations. Communication was made via phone or email to state agencies or trauma advisory committees to obtain or confirm the absence of guidelines where public data was unavailable. Guideline criteria were abstracted and grouped into domains of Center for Disease Control Field Triage Criteria: pattern/anatomy of injury, vital signs, special populations, and mechanisms of injury. Re-triage criteria were summarized across states using median and interquartile ranges for continuous data and frequencies for categorical data. Demographic data of states with and without re-triage guidelines were compared using the Wilcoxon rank sum test. ResultsRe-triage guidelines were identified for 22 of 50 states (44%). Common anatomy of injury criteria included head trauma (91% of states with guidelines), spinal cord injury (82%), chest injury (77%), and pelvic injury (73%). Common vital signs criteria included Glasgow Coma Score (91% of states) ranging from 8 to 14, systolic blood pressure (36%) ranging from 90 to 100 mm Hg, and respiratory rate (23%) with all using 10 respirations/minute. Common special populations criteria included mechanical ventilation (73% of states), age (68%) ranging from <2 or >60 years, cardiac disease (59%), and pregnancy (55%). No significant demographic differences were found between states with versus without re-triage guidelines. ConclusionA minority of US states have re-triage guidelines. Characterizing existing criteria can inform future guideline development.

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

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 &lt; 15, respiratory rate &lt;10 or ≥ 24 beats/minute, and systolic blood pressure &lt; 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.

Identifying Trauma Patients in Need for Emergency Surgery in the Prehospital Setting: The Prehospital Prediction of In-Hospital Emergency Treatment (PROPHET) Study.

Prehospital field triage often fails to accurately identify the need for emergent surgical or non-surgical procedures, resulting in inefficient resource utilization and increased costs. This study aimed to analyze prehospital factors associated with the need for emergent procedures (such as surgery or interventional angiography) within 6 h of hospital admission. Additionally, our goal was to develop a prehospital triage tool capable of estimating the likelihood of requiring an emergent procedure following hospital admission. We conducted a retrospective observational study, analyzing both prehospital and in-hospital data obtained from the Lombardy Trauma Registry. We conducted a multivariable logistic regression analysis to identify independent predictors of emergency procedures within the first 6 h from admission. Subsequently, we developed and internally validated a triage score composed of factors associated with the probability of requiring an emergency procedure. The study included a total of 3985 patients, among whom 295 (7.4%) required an emergent procedure within 6 h. Age, penetrating injury, downfall, cardiac arrest, poor neurological status, endotracheal intubation, systolic pressure, diastolic pressure, shock index, respiratory rate and tachycardia were identified as predictors of requiring an emergency procedure. A triage score generated from these predictors showed a good predictive power (AUC of the ROC curve: 0.81) to identify patients requiring an emergent surgical or non-surgical procedure within 6 h from hospital admission. The proposed triage score might contribute to predicting the need for immediate resource availability in trauma patients.

On Scene Injury Severity Prediction (OSISP) model for trauma developed using the Swedish Trauma Registry

BackgroundProviding optimal care for trauma, the leading cause of death for young adults, remains a challenge e.g., due to field triage limitations in assessing a patient’s condition and deciding on transport destination. Data-driven On Scene Injury Severity Prediction (OSISP) models for motor vehicle crashes have shown potential for providing real-time decision support. The objective of this study is therefore to evaluate if an Artificial Intelligence (AI) based clinical decision support system can identify severely injured trauma patients in the prehospital setting.MethodsThe Swedish Trauma Registry was used to train and validate five models – Logistic Regression, Random Forest, XGBoost, Support Vector Machine and Artificial Neural Network – in a stratified 10-fold cross validation setting and hold-out analysis. The models performed binary classification of the New Injury Severity Score and were evaluated using accuracy metrics, area under the receiver operating characteristic curve (AUC) and Precision-Recall curve (AUCPR), and under- and overtriage rates.ResultsThere were 75,602 registrations between 2013–2020 and 47,357 (62.6%) remained after eligibility criteria were applied. Models were based on 21 predictors, including injury location. From the clinical outcome, about 40% of patients were undertriaged and 46% were overtriaged. Models demonstrated potential for improved triaging and yielded AUC between 0.80–0.89 and AUCPR between 0.43–0.62.ConclusionsAI based OSISP models have potential to provide support during assessment of injury severity. The findings may be used for developing tools to complement field triage protocols, with potential to improve prehospital trauma care and thereby reduce morbidity and mortality for a large patient population.

Association between blood pressure recording in prehospital setting and patient outcome in pediatric trauma patients: A propensity score matching study.

Rapid identification of the severity of injuries in the field is important to ensure appropriate hospital care for better outcomes. Vital signs are used as a field triage tool for critically ill or injured patients in prehospital settings. Several studies have shown that recording vital signs, especially blood pressure, in pediatric patients is sometimes omitted in prehospital settings compared with that in adults. However, little is known about the association between the lack of measurement of prehospital vital signs and patient outcomes. In this study, we examined the association between the rate of vital sign measurements in the field and patient outcomes in injured children. This study analyzed secondary data from the Japan Trauma Data Bank. We included pediatric patients (0-17 years) with injuries who were transported by emergency medical services. Hospital survival was the primary outcome. We performed a propensity-matched analysis with nearest-neighbor matching without replacement by adjusting for demographic and clinical variables to evaluate the effect of recording vital signs. During the study period, 13,413 pediatric patients were included. There were 9,187 and 1,798 patients with and without prehospital blood pressure records, respectively. After matching, there were no differences in the patient characteristics or disease severity. Hospital mortality was significantly higher in the nonrecorded group than in the recorded group (4.3% vs. 1.1%; p < 0.001). The multiple logistic regression analysis results showed no prehospital record of blood pressure being associated with death (odds ratio [OR], 6.82; 95% confidence interval [CI], 2.40-19.33). Glasgow Coma Scale score and Injury Severity Score were also associated with death (OR, 0.71; 95% CI, 0.63-0.81 and OR, 1.10; 95% CI, 1.06-11.14, respectively). Pediatric patients without any blood pressure records in prehospital settings had higher mortality rates than those with prehospital blood pressure records. Therapeutic/Care Management; Level III.

Field Measures Are All You Need: Predicting Need for Surgery in Elderly Ground-Level Fall Patients via Machine Learning.

As ground-level falls (GLFs) are a significant cause of mortality in elderly patients, field triage plays an essential role in patient outcomes. This research investigates how machine learning algorithms can supplement traditional t-tests to recognize statistically significant patterns in medical data and to aid clinical guidelines. This is a retrospective study using data from 715 GLF patients over 75years old. We first calculated P-values for each recorded factor to determine the factor's significance in contributing to a need for surgery (P < .05 is significant). We then utilized the XGBoost machine learning method to rank contributing factors. We applied SHapley Additive exPlanations (SHAP) values to interpret the feature importance and provide clinical guidance via decision trees. The three most significant P-values when comparing patients with and without surgery are as follows: Glasgow Coma Scale (GCS) (P < .001), no comorbidities (P < .001), and transfer-in (P = .019). The XGBoost algorithm determined that GCS and systolic blood pressure contribute most strongly. The prediction accuracy of these XGBoost results based on the test/train split was 90.3%. When compared to P-values, XGBoost provides more robust, detailed results regarding the factors that suggest a need for surgery. This demonstrates the clinical applicability of machine learning algorithms. Paramedics can use resulting decision trees to inform medical decision-making in real time. XGBoost's generalizability power increases with more data and can be tuned to prospectively assist individual hospitals.

MCI (Mass Casualty Incident) Response Support for Palestine Refugee Hospitals in Lebanon

Introduction:The Japanese Red Cross Society has been supporting MCI response support for Palestine hospitals in Lebanon since 2018.Method:It was started from a hospital as a single topic in a one-year ER trauma course, which was combined with an ER triage course. In the next hospital it was revised into not only a theological lecture course but also a field triage training course with pre-hospital volunteers. As a result, when the Beirut explosion happened in 2020, the first hospital could accept more than 50 green patients at once, and the second one sent a pre-hospital team to do triage at the scene showing that training courses were useful in a real MCI case .Results:At this time, support is being provided in a new hospital by making use of these experiences. A current report will be available when this association is held.Conclusion:MCI response support for refugee camps is improving through trial and error, which would have much in common with other MCI responses in many countries and areas.

Development and Asian-wide validation of the Grade for Interpretable Field Triage (GIFT) for predicting mortality in pre-hospital patients using the Pan-Asian Trauma Outcomes Study (PATOS)

Field triage is critical in injury patients as the appropriate transport of patients to trauma centers is directly associated with clinical outcomes. Several prehospital triage scores have been developed in Western and European cohorts; however, their validity and applicability in Asia remains unclear. Therefore, we aimed to develop and validate an interpretable field triage scoring systems based on a multinational trauma registry in Asia. This retrospective and multinational cohort study included all adult transferred injury patients from Korea, Malaysia, Vietnam, and Taiwan between 2016 and 2018. The outcome of interest was a death in the emergency department (ED) after the patients' ED visit. Using these results, we developed the interpretable field triage score with the Korea registry using an interpretable machine learning framework and validated the score externally. The performance of each country's score was assessed using the area under the receiver operating characteristic curve (AUROC). Furthermore, a website for real-world application was developed using R Shiny. The study population included 26,294, 9404, 673 and 826 transferred injury patients between 2016 and 2018 from Korea, Malaysia, Vietnam, and Taiwan, respectively. The corresponding rates of a death in the ED were 0.30%, 0.60%, 4.0%, and 4.6% respectively. Age and vital sign were found to be the significant variables for predicting mortality. External validation showed the accuracy of the model with an AUROC of 0.756-0.850. The Grade for Interpretable Field Triage (GIFT) score is an interpretable and practical tool to predict mortality in field triage for trauma. This research was supported by a grant of the Korea Health Technology R&D Project through the Korea Health Industry Development Institute (KHIDI), funded by the Ministry of Health & Welfare, Republic of Korea (Grant Number: HI19C1328).

Patient Outcomes Based on the 2011 CDC Guidelines for Field Triage of Injured Patients.

Patient Outcomes Based on the 2011 CDC Guidelines for Field Triage of Injured Patients.