title: Prospective Validation of the National Field Triage Guidelines for Identifying Seriously Injured Persons.
abstract: BACKGROUND
  The national field trauma triage guidelines have been widely implemented in US trauma systems, but never prospectively validated. We sought to prospectively validate the guidelines, as applied by out-of-hospital providers, for identifying high-risk trauma patients.
  
  
  METHODS
  This was an out-of-hospital prospective cohort study from January 1, 2011 through December 31, 2011 with 44 Emergency Medical Services agencies in 7 counties in 2 states. We enrolled injured patients transported to 28 acute care hospitals, including 7 major trauma centers (Level I and II trauma hospitals) and 21 nontrauma hospitals. The primary exposure term was Emergency Medical Services' use of one or more field triage criteria in the national field triage guidelines. Outcomes included Injured Severity Score ≥16 (primary) and critical resource use within 24 hours of emergency department arrival (secondary).
  
  
  RESULTS
  We enrolled 53,487 injured children and adults transported by Emergency Medical Services to an acute care hospital, 17,633 of which were sampled for the primary analysis; 13.9% met field triage guidelines, 3.1% had Injury Severity Score ≥16, and 1.7% required early critical resources. The sensitivity and specificity of the field triage guidelines were 66.2% (95% CI, 60.2-71.7%) and 87.8% (95% CI, 87.7-88.0%) for Injury Severity Score ≥16 and 80.1% (95% CI, 65.8-89.4%) and 87.3% (95% CI 87.1-87.4%) for early critical resource use. Triage guideline sensitivity decreased with age, from 87.4% in children to 51.8% in older adults.
  
  
  CONCLUSIONS
  The national field triage guidelines are relatively insensitive for identifying seriously injured patients and patients requiring early critical interventions, particularly among older adults.
authors.affiliation: Center for Policy and Research in Emergency Medicine, Department of Emergency Medicine, Oregon Health & Science University, Portland, OR. Electronic address: newgardc@ohsu.edu.
authors.forename: Craig D
authors.initials: CD
authors.lastname: Newgard
authors.affiliation: Center for Policy and Research in Emergency Medicine, Department of Emergency Medicine, Oregon Health & Science University, Portland, OR; Department of Public Health and Preventive Medicine, Oregon Health & Science University, Portland, OR.
authors.forename: Rongwei
authors.initials: R
authors.lastname: Fu
authors.affiliation: Center for Policy and Research in Emergency Medicine, Department of Emergency Medicine, Oregon Health & Science University, Portland, OR.
authors.forename: Dana
authors.initials: D
authors.lastname: Zive
authors.affiliation: Department of Internal Medicine, University of Washington, Seattle, WA; King County Emergency Medical Services, Seattle, WA.
authors.forename: Tom
authors.initials: T
authors.lastname: Rea
authors.affiliation: Center for Policy and Research in Emergency Medicine, Department of Emergency Medicine, Oregon Health & Science University, Portland, OR.
authors.forename: Susan
authors.initials: S
authors.lastname: Malveau
authors.affiliation: Center for Policy and Research in Emergency Medicine, Department of Emergency Medicine, Oregon Health & Science University, Portland, OR; Tualatin Valley Fire & Rescue, Tualatin, OR.
authors.forename: Mohamud
authors.initials: M
authors.lastname: Daya
authors.affiliation: Center for Policy and Research in Emergency Medicine, Department of Emergency Medicine, Oregon Health & Science University, Portland, OR; Multnomah County Emergency Medical Services, Portland, OR.
authors.forename: Jonathan
authors.initials: J
authors.lastname: Jui
authors.affiliation: Center for Policy and Research in Emergency Medicine, Department of Emergency Medicine, Oregon Health & Science University, Portland, OR.
authors.forename: Denise E
authors.initials: DE
authors.lastname: Griffiths
authors.affiliation: Clark Regional Emergency Services Agency, Vancouver, WA; PeaceHealth Southwest Medical Center, Vancouver, WA.
authors.forename: Lynn
authors.initials: L
authors.lastname: Wittwer
authors.affiliation: Providence Portland Medical Center, Portland, OR; Lake Oswego Fire Department, Lake Oswego, OR.
authors.forename: Ritu
authors.initials: R
authors.lastname: Sahni
authors.affiliation: Legacy Emanuel Trauma Program, Portland, OR.
authors.forename: K Dean
authors.initials: KD
authors.lastname: Gubler
authors.affiliation: Washington County Emergency Medical Services, Hillsboro, OR.
authors.forename: Jonathan
authors.initials: J
authors.lastname: Chin
authors.affiliation: Department of Surgery, University of Washington, Seattle, WA.
authors.forename: Pat
authors.initials: P
authors.lastname: Klotz
authors.affiliation: Asante Three Rivers Medical Center Trauma Program, Grants Pass, OR.
authors.forename: Stephanie
authors.initials: S
authors.lastname: Somerville
authors.affiliation: American Medical Response, Clackamas, OR.
authors.forename: Tina
authors.initials: T
authors.lastname: Beeler
authors.affiliation: Skamania County Emergency Medical Services, Stevenson, WA.
authors.forename: T J
authors.initials: TJ
authors.lastname: Bishop
authors.affiliation: Department of Surgery, University of Washington, Seattle, WA.
authors.forename: Tara N
authors.initials: TN
authors.lastname: Garland
authors.affiliation: Department of Surgery, University of Washington, Seattle, WA.
authors.forename: Eileen
authors.initials: E
authors.lastname: Bulger
mesh_terms: D000293:Adolescent; D000328:Adult; D002648:Child; D002675:Child, Preschool; D003422:Critical Care; D004636:Emergency Service, Hospital; D005260:Female; D006760:Hospitalization; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D015601:Injury Severity Score; D008297:Male; D008875:Middle Aged; D017410:Practice Guidelines as Topic; D011446:Prospective Studies; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D014218:Triage; D014947:Wounds and Injuries / Q000145:classification* / Q000175:diagnosis / Q000628:therapy; D055815:Young Adult