Evaluation of the Prehospital Index, presence of high-velocity impact and judgment of emergency medical technicians as criteria for trauma triage.
OBJECTIVE
We sought to evaluate the performance of the Prehospital Index (PHI), the high velocity impact (HVI) criterion and emergency medical technician (EMT) judgment for the prehospital triage of injured patients.


METHODS
The study population included all prehospital trauma patients transported by an emergency medical service to 2 level I trauma centres for adults. All prehospital run sheets were linked to trauma registry data. The main outcome was severe trauma, defined as death within 72 hours, admission to the intensive care unit within 24 hours or an Injury Severity Score greater than 15. We assessed sensitivity, specificity and rates of overtriage.


RESULTS
Of 16,805 patients in the study population, 1113 (6.62%) had severe trauma. The combination of all 3 triage criteria (PHI score > or = 4, HVI presence and EMT judgment) performed best for identifying patients with severe trauma, with a sensitivity of 74.2% but with an overtriage rate of 85.1%. Alone, EMT judgment had the highest sensitivity and a PHI score of 4 or greater had the low est rate of overtriage.


CONCLUSIONS
Although the combination of PHI score, HVI presence and EMT judgment offers the highest sensitivity for the identification of patients that could benefit from direct transport to a level I trauma centre, overall sensitivity remains low and over triage is high. More research is required to improve prehospital triage.
Lavoie
André
A
Unité de recherche en traumatologie urgence soins intensifs, Centre de recherche du CHA (Hôpital de l'Enfant Jésus), Québec City, Québec. andre.lavoie.trauma.cha@ssss.gouv.qc.ca
Emond
Marcel
M
Moore
Lynne
L
Camden
Stéphanie
S
Liberman
Moishe
M
D000328:Adult; D004632:Emergency Medical Services / Q000458:organization & administration*; D004634:Emergency Medical Technicians; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011792:Quebec; D012372:ROC Curve; D015599:Trauma Severity Indices; D014218:Triage; D014947:Wounds and Injuries / Q000175:diagnosis*