title: A regional trauma system to optimize the pre-hospital triage of trauma patients.
abstract: BACKGROUND
  Pre-hospital triage is a key element in a trauma system that aims to admit patients to the most suitable trauma center, and may decrease intra-hospital mortality. We evaluated the performance of a pre-hospital procedure in a regional trauma system through measurements of the quality of pre-hospital medical assessment and the efficacy of a triage protocol.
  
  
  METHODS
  Our regional trauma system included 13 hospitals categorized as Level I, II or III trauma centers according to their technical facilities. Each patient was graded A, B or C by an emergency physician, according to the seriousness of their injuries at presentation on scene. The triage was performed according to this grading and the categorization of centers. This study is a registry analysis of a three-year period (2009 to 2011).
  
  
  RESULTS
  Of the 3,428 studied patients, 2,572 were graded using the pre-hospital grading system (Graded group). The pre-hospital gradation was closely related with injury severity score (ISS) and intra-hospital mortality rate. The triage protocol had a sensitivity of 92% (95% confidence interval (CI) 90% to 93%) and a specificity of 41% (95% CI 39% to 44%) to predict adequate admission of patients with ISS more than 15. A total of 856 patients were not graded at the scene (Non-graded group). Undertriage rate was significantly reduced in the Graded group compared with the Non-graded group, with a relative risk of 0.47 (95% CI 0.40 to 0.56) according to the definition of the American College of Surgeons Committee on Trauma (P <0.001). Where adjusted for trauma severity, the expected mortality rate at discharge from hospital was higher than observed mortality, with a difference of +2.0% (95% CI 1.4 to 2.6%; P <0.01).
  
  
  CONCLUSIONS
  Implementation of a regional trauma system with a pre-hospital triage procedure was effective in detecting severe trauma patients and in lowering the rate of pre-hospital undertriage. A beneficial effect on outcome of such an organization is suggested.
authors.affiliation: Department of Anaesthesiology and Critical Care, Grenoble University Hospital, Hôpital Albert Michallon, BP 217, F-38043, Grenoble, France. PBouzat@chu-grenoble.fr.|Grenoble Alps University, F-38000, Grenoble, France. PBouzat@chu-grenoble.fr.
authors.forename: Pierre
authors.initials: P
authors.lastname: Bouzat
authors.affiliation: Emergency Medical Service, Annecy Hospital, F-7400, Annecy, France. FXAgeron@ch-annecygenevois.fr.
authors.forename: François-Xavier
authors.initials: FX
authors.lastname: Ageron
authors.affiliation: Department of Anaesthesiology and Critical Care, Grenoble University Hospital, Hôpital Albert Michallon, BP 217, F-38043, Grenoble, France. JBrun@chu-grenoble.fr.
authors.forename: Julien
authors.initials: J
authors.lastname: Brun
authors.affiliation: Department of Critical Care, Annecy Hospital, F-74000, Annecy, France. ALevrat@ch-annecygenevois.fr.
authors.forename: Albrice
authors.initials: A
authors.lastname: Levrat
authors.affiliation: Department of Anaesthesiology and Critical Care, Grenoble University Hospital, Hôpital Albert Michallon, BP 217, F-38043, Grenoble, France. MBerthet@chu-grenoble.fr.
authors.forename: Marion
authors.initials: M
authors.lastname: Berthet
authors.affiliation: Emergency Medical Service, Grenoble University Hospital, Hôpital Albert Michallon, BP 217, F-38043, Grenoble, France. ERancurel@chu-grenoble.fr.
authors.forename: Elisabeth
authors.initials: E
authors.lastname: Rancurel
authors.affiliation: Department of Critical Care, Chambery Hospital, F-73000, Chambery, France. jeanmarc.thouret@ch-chambery.fr.
authors.forename: Jean-Marc
authors.initials: JM
authors.lastname: Thouret
authors.affiliation: Department of Medical Imaging, Grenoble University Hospital, Hôpital Albert Michallon, BP 217, F-38043, Grenoble, France. FThony@chu-grenoble.fr.
authors.forename: Frederic
authors.initials: F
authors.lastname: Thony
authors.affiliation: Department of Visceral Surgery, Grenoble University Hospital, Hôpital Albert Michallon, BP 217, F-38043, Grenoble, France. CArvieux@chu-grenoble.fr.
authors.forename: Catherine
authors.initials: C
authors.lastname: Arvieux
authors.affiliation: Department of Anaesthesiology and Critical Care, Grenoble University Hospital, Hôpital Albert Michallon, BP 217, F-38043, Grenoble, France. JFPayen@chu-grenoble.fr.|Grenoble Alps University, F-38000, Grenoble, France. JFPayen@chu-grenoble.fr.
authors.forename: Jean-François
authors.initials: JF
authors.lastname: Payen
mesh_terms: D000328:Adult; D004632:Emergency Medical Services; D005260:Female; D005602:France / Q000453:epidemiology; D006801:Humans; D015601:Injury Severity Score; D008297:Male; D012042:Registries; D012680:Sensitivity and Specificity; D014193:Trauma Centers; D014218:Triage / Q000379:methods*; D014947:Wounds and Injuries / Q000401:mortality