Accuracy of prehospital triage of trauma patients by emergency physicians: a retrospective study in western Switzerland.
OBJECTIVE
Accurate identification of major trauma patients in the prehospital setting positively affects survival and resource utilization. Triage algorithms using predictive criteria of injury severity have been identified in paramedic-based prehospital systems. Our rescue system is based on prehospital paramedics and emergency physicians. The aim of this study was to evaluate the accuracy of the prehospital triage performed by physicians and to identify the predictive factors leading to errors of triage.


METHODS
Retrospective study of trauma patients triaged by physicians. Prehospital triage was analyzed using criteria defining major trauma victims (MTVs, Injury Severity Score >15, admission to ICU, need for immediate surgery and death within 48 h). Adequate triage was defined as MTVs oriented to the trauma centre or non-MTV (NMTV) oriented to regional hospitals.


RESULTS
One thousand six hundred and eighty-five patients (blunt trauma 96%) were included (558 MTV and 1127 NMTV). Triage was adequate in 1455 patients (86.4%). Overtriage occurred in 171 cases (10.1%) and undertriage in 59 cases (3.5%). Sensitivity and specificity was 90 and 85%, respectively, whereas positive predictive value and negative predictive value were 75 and 94%, respectively. Using logistic regression analysis, significant (P<0.05) predictors of undertriage were head or thorax injuries (odds ratio >2.5). Predictors of overtriage were paediatric age group, pedestrian or 2 wheel-vehicle road traffic accidents (odds ratio >2.0).


CONCLUSIONS
Physicians using clinical judgement provide effective prehospital triage of trauma patients. Only a few factors predicting errors in triage process were identified in this study.
Carron
Pierre-Nicolas
PN
Emergency Service, University Hospital Center, Lausanne, Switzerland. pierre-nicolas.carron@chuv.ch
Taffe
Patrick
P
Ribordy
Vincent
V
Schoettker
Patrick
P
Fishman
Daniel
D
Yersin
Bertrand
B
D000488:Allied Health Personnel; D001291:Attitude of Health Personnel; D015331:Cohort Studies; D004632:Emergency Medical Services / Q000379:methods*; D004635:Emergency Medicine / Q000458:organization & administration; D005260:Female; D006801:Humans; D015601:Injury Severity Score; D008297:Male; D016017:Odds Ratio; D010348:Patient Care Team / Q000458:organization & administration*; D010818:Practice Patterns, Physicians'; D011786:Quality Control; D012042:Registries; D012044:Regression Analysis; D012189:Retrospective Studies; D016019:Survival Analysis; D013557:Switzerland; D016896:Treatment Outcome; D014218:Triage / Q000379:methods* / Q000592:standards; D014947:Wounds and Injuries / Q000175:diagnosis* / Q000401:mortality / Q000628:therapy