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A regional trauma system to optimize the pre-hospital triage of trauma patients
INTRODUCTION: 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...
Autores principales: | , , , , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
BioMed Central
2015
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4403891/ https://www.ncbi.nlm.nih.gov/pubmed/25887150 http://dx.doi.org/10.1186/s13054-015-0835-7 |
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author | Bouzat, Pierre Ageron, François-Xavier Brun, Julien Levrat, Albrice Berthet, Marion Rancurel, Elisabeth Thouret, Jean-Marc Thony, Frederic Arvieux, Catherine Payen, Jean-François |
author_facet | Bouzat, Pierre Ageron, François-Xavier Brun, Julien Levrat, Albrice Berthet, Marion Rancurel, Elisabeth Thouret, Jean-Marc Thony, Frederic Arvieux, Catherine Payen, Jean-François |
author_sort | Bouzat, Pierre |
collection | PubMed |
description | INTRODUCTION: 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. METHODS: 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). RESULTS: 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). CONCLUSIONS: 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. ELECTRONIC SUPPLEMENTARY MATERIAL: The online version of this article (doi:10.1186/s13054-015-0835-7) contains supplementary material, which is available to authorized users. |
format | Online Article Text |
id | pubmed-4403891 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2015 |
publisher | BioMed Central |
record_format | MEDLINE/PubMed |
spelling | pubmed-44038912015-04-21 A regional trauma system to optimize the pre-hospital triage of trauma patients Bouzat, Pierre Ageron, François-Xavier Brun, Julien Levrat, Albrice Berthet, Marion Rancurel, Elisabeth Thouret, Jean-Marc Thony, Frederic Arvieux, Catherine Payen, Jean-François Crit Care Research INTRODUCTION: 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. METHODS: 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). RESULTS: 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). CONCLUSIONS: 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. ELECTRONIC SUPPLEMENTARY MATERIAL: The online version of this article (doi:10.1186/s13054-015-0835-7) contains supplementary material, which is available to authorized users. BioMed Central 2015-03-18 2015 /pmc/articles/PMC4403891/ /pubmed/25887150 http://dx.doi.org/10.1186/s13054-015-0835-7 Text en © Bouzat et al.; licensee BioMed Central. 2015 This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly credited. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated. |
spellingShingle | Research Bouzat, Pierre Ageron, François-Xavier Brun, Julien Levrat, Albrice Berthet, Marion Rancurel, Elisabeth Thouret, Jean-Marc Thony, Frederic Arvieux, Catherine Payen, Jean-François A regional trauma system to optimize the pre-hospital triage of trauma patients |
title | A regional trauma system to optimize the pre-hospital triage of trauma patients |
title_full | A regional trauma system to optimize the pre-hospital triage of trauma patients |
title_fullStr | A regional trauma system to optimize the pre-hospital triage of trauma patients |
title_full_unstemmed | A regional trauma system to optimize the pre-hospital triage of trauma patients |
title_short | A regional trauma system to optimize the pre-hospital triage of trauma patients |
title_sort | regional trauma system to optimize the pre-hospital triage of trauma patients |
topic | Research |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4403891/ https://www.ncbi.nlm.nih.gov/pubmed/25887150 http://dx.doi.org/10.1186/s13054-015-0835-7 |
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