title: Performance of the New South Wales Ambulance Service major trauma transport protocol (T1) at an inner city trauma centre.
abstract: OBJECTIVE
  To evaluate the performance of a newly implemented prehospital trauma triage (T1) protocol in New South Wales for patients transported to an inner city major trauma centre.
  
  
  METHODS
  An observational study was conducted over 1 year. Prehospital data and injury characteristics were collected prospectively for all hospital trauma team activations and injury presentations transported by Ambulance Service of New South Wales. Univariate comparison of T1- and non-T1-transported patients was performed and sensitivity, specificity, overtriage and undertriage rates were calculated. The outcomes studied were Injury Severity Score >15 and major outcome (composite of in-hospital death and/or transferred from the ED to operating theatre or intensive care unit). Factors associated with undertriage were determined with univariate analysis.
  
  
  RESULTS
  A total of 2664 ambulance arrivals for trauma were studied with 767(29%) transported on the T1 protocol. T1-transported patients were associated with more severe injury (23% vs 6%, P < 0.001) and major outcomes (30% vs 10%, P < 0.001) compared with non-T1-transported patients. The sensitivity of the T1 protocol for severe injury was 63% with a positive predictive value of 23%. The undertriage and overtriage rates for severe injury were 12% and 77%, respectively. Undertriaged patients were elderly with falls as the predominant mechanism of injury.
  
  
  CONCLUSIONS
  The sensitivity and undertriage rates associated with the T1 protocol indicate the ongoing need for secondary triage at designated trauma centres and refinement of the protocol to include age as a criterion.
authors.affiliation: Department of Trauma Services Emergency Department, Royal Prince Alfred Hospital, Missenden Road, Camperdown, NSW 2050, Australia. dinh.mm@gmail.com
authors.forename: Michael M
authors.initials: MM
authors.lastname: Dinh
authors.forename: Matthew
authors.initials: M
authors.lastname: Oliver
authors.forename: Kendall J
authors.initials: KJ
authors.lastname: Bein
authors.forename: Susan
authors.initials: S
authors.lastname: Roncal
authors.forename: Christopher M
authors.initials: CM
authors.lastname: Byrne
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000552:Ambulances / Q000592:standards*; D002985:Clinical Protocols / Q000592:standards*; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data; D005260:Female; D006801:Humans; D015601:Injury Severity Score; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D009517:New South Wales; D011237:Predictive Value of Tests; D012680:Sensitivity and Specificity; D014218:Triage / Q000592:standards*; D055815:Young Adult