title: A multisite assessment of the American College of Surgeons Committee on Trauma field triage decision scheme for identifying seriously injured children and adults.
abstract: BACKGROUND
  The American College of Surgeons Committee on Trauma (ACSCOT) has developed and updated field trauma triage protocols for decades, yet the ability to identify major trauma patients remains unclear. We estimate the diagnostic value of the Field Triage Decision Scheme for identifying major trauma patients (Injury Severity Score [ISS] ≥ 16) in a large and diverse multisite cohort.
  
  
  METHODS
  This was a retrospective cohort study of injured children and adults transported by 94 emergency medical services (EMS) agencies to 122 hospitals in 7 regions of the Western US from 2006 through 2008. Patients who met any of the field trauma triage criteria (per EMS personnel) were considered triage positive. Hospital outcomes measures were probabilistically linked to EMS records through trauma registries, state discharge data, and emergency department data. The primary outcome defining a "major trauma patient" was ISS ≥ 16.
  
  
  RESULTS
  There were 122,345 injured patients evaluated and transported by EMS over the 3-year period, 34.5% of whom met at least 1 triage criterion and 5.8% had ISS ≥ 16. The overall sensitivity and specificity of the criteria for identifying major trauma patients were 85.8% (95% CI 85.0% to 86.6%) and 68.7% (95% CI 68.4% to 68.9%), respectively. Triage sensitivity and specificity, respectively, differed by age: 84.1% and 66.4% (0 to 17 years); 89.5% and 64.3% (18 to 54 years); and 79.9% and 75.4% (≥55 years). Evaluating the diagnostic value of triage by hospital destination (transport to Level I/II trauma centers) did not substantially improve these findings.
  
  
  CONCLUSIONS
  The sensitivity of the Field Triage Decision Scheme for identifying major trauma patients is lower and specificity higher than previously described, particularly among elders.
authors: Center for Policy and Research in Emergency Medicine, Department of Emergency Medicine, Oregon Health & Science University, Portland, OR, USA. newgardc@ohsu.edu
authors: Craig D
authors: CD
authors: Newgard
authors: Dana
authors: D
authors: Zive
authors: James F
authors: JF
authors: Holmes
authors: Eileen M
authors: EM
authors: Bulger
authors: Kristan
authors: K
authors: Staudenmayer
authors: Michael
authors: M
authors: Liao
authors: Thomas
authors: T
authors: Rea
authors: Renee Y
authors: RY
authors: Hsia
authors: N Ewen
authors: NE
authors: Wang
authors: Ross
authors: R
authors: Fleischman
authors: Jonathan
authors: J
authors: Jui
authors: N Clay
authors: NC
authors: Mann
authors: Jason S
authors: JS
authors: Haukoos
authors: Karl A
authors: KA
authors: Sporer
authors: K Dean
authors: KD
authors: Gubler
authors: Jerris R
authors: JR
authors: Hedges
mesh_terms: D000293:Adolescent; D000328:Adult; D000367:Age Factors; D002648:Child; D002985:Clinical Protocols; D015331:Cohort Studies; D003661:Decision Support Techniques; D003663:Decision Trees; D005260:Female; D006801:Humans; D015601:Injury Severity Score; D008297:Male; D008875:Middle Aged; D012680:Sensitivity and Specificity; D014218:Triage; D014947:Wounds and Injuries / Q000175:diagnosis* / Q000209:etiology / Q000628:therapy; D055815:Young Adult