title: Vittel criteria for severe trauma triage: Characteristics of over-triage.
abstract: OBJECTIVE
  Over-triage rates related to the use of Vittel criteria are unknown. We compared severe stable trauma patients with and without significant visceral injuries.
  
  
  METHODS
  A single-centre retrospective analysis of a single-centre prospective cohort.
  
  
  METHODS
  Trauma patients with at least one positive Vittel criterion from June 2010 to January 2012 in a level-1 trauma centre. Initial management included a systematic whole-body scanner. All significant lesions in stable trauma patients were recorded.
  
  
  RESULTS
  A total of 252 trauma patients were admitted. One hundred and twenty were stable. In this group without vital distress, 72 (60%) had at least one occult lesion, 21 (17.5%) had an isolated orthopaedic injury and 27 (22.5%) had no injury. Thoracic injuries accounted for 44% of visceral injuries, abdominal for 17%, spinal for 16% and cerebral for 15%. Overall, the over-triage rate was 19%. Surgery for significant visceral injury was performed in 13 patients (18%) and arteriography in 4 patients (5.5%). Admission in an intensive care unit was required for 13 patients with occult injuries and for one patient without such a lesion (18% versus 2%, P=0.008). Hospital stays were longer in the group with visceral injuries (4±7 versus 9±8days; P=0.006).
  
  
  CONCLUSIONS
  Vittel criteria use in trauma patients induces an acceptable over-triage rate. A large proportion of stable trauma patients have occult lesions. These visceral injuries frequently require special care. These data highlight the imperative need to transport major trauma patients immediately to a dedicated trauma centre and supports whole-body scanner use.
authors.affiliation: Anaesthesia and Intensive Care Department, Sainte-Anne Military Hospital, BP 20545, 83041 Toulon cedex 9, France. Electronic address: jean.cotte@gmail.com.
authors.forename: Jean
authors.initials: J
authors.lastname: Cotte
authors.affiliation: Emergency Department, Sainte-Anne Military Hospital, BP 20545, 83041 Toulon cedex 9, France. Electronic address: fredrik.courjon@yahoo.fr.
authors.forename: Fredrik
authors.initials: F
authors.lastname: Courjon
authors.affiliation: Emergency Department, Sainte-Anne Military Hospital, BP 20545, 83041 Toulon cedex 9, France. Electronic address: docteur.beaume@gmail.com.
authors.forename: Sébastien
authors.initials: S
authors.lastname: Beaume
authors.affiliation: Anaesthesia and Intensive Care Department, Sainte-Anne Military Hospital, BP 20545, 83041 Toulon cedex 9, France. Electronic address: prunet.bertrand@orange.fr.
authors.forename: Bertrand
authors.initials: B
authors.lastname: Prunet
authors.affiliation: Anaesthesia and Intensive Care Department, Sainte-Anne Military Hospital, BP 20545, 83041 Toulon cedex 9, France. Electronic address: bordes.julien@neuf.fr.
authors.forename: Julien
authors.initials: J
authors.lastname: Bordes
authors.affiliation: Anaesthesia and Intensive Care Department, Sainte-Anne Military Hospital, BP 20545, 83041 Toulon cedex 9, France. Electronic address: ced040@hotmail.fr.
authors.forename: Cédric
authors.initials: C
authors.lastname: N'Guyen
authors.affiliation: Anaesthesia and Intensive Care Department, Sainte-Anne Military Hospital, BP 20545, 83041 Toulon cedex 9, France. Electronic address: contargyris@hotmail.com.
authors.forename: Claire
authors.initials: C
authors.lastname: Contargyris
authors.affiliation: Anaesthesia and Intensive Care Department, Sainte-Anne Military Hospital, BP 20545, 83041 Toulon cedex 9, France. Electronic address: gllacroix@aol.com.
authors.forename: Guillaume
authors.initials: G
authors.lastname: Lacroix
authors.affiliation: Anaesthesia and Intensive Care Department, Sainte-Anne Military Hospital, BP 20545, 83041 Toulon cedex 9, France. Electronic address: ambroise.montcriol@free.fr.
authors.forename: Ambroise
authors.initials: A
authors.lastname: Montcriol
authors.affiliation: Anaesthesia and Intensive Care Department, Sainte-Anne Military Hospital, BP 20545, 83041 Toulon cedex 9, France. Electronic address: kaiserenmission@gmail.com.
authors.forename: Eric
authors.initials: E
authors.lastname: Kaiser
authors.affiliation: Anaesthesia and Intensive Care Department, Sainte-Anne Military Hospital, BP 20545, 83041 Toulon cedex 9, France. Electronic address: eric.meaudre@club-internet.fr.
authors.forename: Eric
authors.initials: E
authors.lastname: Meaudre
mesh_terms: D000328:Adult; D000368:Aged; D000792:Angiography; D003422:Critical Care; D005260:Female; D050723:Fractures, Bone / Q000000981:diagnostic imaging / Q000601:surgery; D005596:Fractures, Closed / Q000000981:diagnostic imaging / Q000601:surgery; D006801:Humans; D008136:Longevity; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D013898:Thoracic Injuries / Q000000981:diagnostic imaging / Q000628:therapy; D014193:Trauma Centers; D014218:Triage / Q000592:standards*; D051598:Whole Body Imaging; D014947:Wounds and Injuries / Q000000981:diagnostic imaging / Q000601:surgery / Q000628:therapy*
keywords: Severe trauma; Triage; Vittel criteria