title: Adherence with the pre-hospital triage protocol in the transport of injured patients in an urban setting.
abstract: BACKGROUND
  Pre-hospital triage protocols are an important component in the treatment of injured patients. The aim was to determine the level of, and factors associated with, adherence to the pre-hospital trauma triage criteria for urban patients transported in New South Wales, Australia.
  
  
  METHODS
  This retrospective study included patients injured in urban areas who were transported by road for the treatment of traumatic injuries in the period 1 July 2006 to 30 June 2007.
  
  
  RESULTS
  Of the 57,775 transported to hospital due to traumatic injury, 9344 (16%) met one or more of the pre-hospital triage criteria. Of these, 74% were transported to a protocol adherent major or regional trauma centre. Adherence rates differed by triage criteria met and was lowest for patients meeting physiologic-only criteria (63.5%) and highest for patients meeting all three triage criteria of physiology, mechanism and injury (85.4%). Female gender, increasing patient age, patients classified as having had a fall, the qualification level of treating officer and patients transported between midday to 18:00 (relative to those transported between midnight to 06:00) were factors associated with significantly lower levels of protocol adherence with respect to hospital destination. Minimal time differences were evident between patients transported to protocol adherent and non-adherent destinations.
  
  
  CONCLUSIONS
  Based on the post hoc evaluation of triage status, adherence to the triage protocol was 74%. Analysis of patient destinations for protocol non-adherence appears to indicate that paramedic interpretation and discretion played a role in determining hospital choice. There was a marginal time difference between those transported to protocol adherent and non-adherent destinations. Future research needs to determine whether deviations from protocol are associated with differential mortality.
authors: Injury Outcomes Research Unit & Accident Research Centre, Monash Injury Research Institute, Monash University, Melbourne, Australia. Michael.Fitzharris@monash.edu
authors: Michael
authors: M
authors: Fitzharris
authors: Mark
authors: M
authors: Stevenson
authors: Paul
authors: P
authors: Middleton
authors: Garry
authors: G
authors: Sinclair
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000552:Ambulances / Q000706:statistics & numerical data*; D002648:Child; D002675:Child, Preschool; D004634:Emergency Medical Technicians / Q000458:organization & administration* / Q000706:statistics & numerical data; D004638:Emergency Treatment; D005260:Female; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D008875:Middle Aged; D009517:New South Wales / Q000453:epidemiology; D017063:Outcome Assessment, Health Care; D017060:Patient Satisfaction; D013997:Time Factors; D014193:Trauma Centers / Q000458:organization & administration* / Q000706:statistics & numerical data; D014218:Triage / Q000458:organization & administration / Q000706:statistics & numerical data; D014505:Urban Population / Q000706:statistics & numerical data*; D014947:Wounds and Injuries / Q000453:epidemiology / Q000628:therapy*; D055815:Young Adult