Evaluation of the prehospital Index, presence of high-velocity impact and judgment of emergency medical technicians as criteria for trauma triage

Objective: We sought to evaluate the performance of the Prehospital Index (PHI), the high-velocity impact (HVI) criterion and emergency medical technician (EMT) judgment for the prehospital triage of injured patients. Methods: The study population included all prehospital trauma patients transported by an emergency medical service to 2 level-I trauma centres for adults. All prehospital run sheets were linked to trauma registry data. The main outcome was severe trauma, defined as death within 72 hours, admission to the intensive care unit within 24 hours or an Injury Severity Score greater than 15. We assessed sensitivity, specificity and rates of overtriage. Results: Of 16 805 patients in the study population, 1113 (6.62%) had severe trauma. The combination of all 3 triage criteria (PHI score [greater than or equal to] 4, HVI presence and EMT judgment) performed best for identifying patients with severe trauma, with a sensitivity of 74.2% but with an overtriage rate of 85.1%. Alone, EMT judgment had the highest sensitivity and a PHI score of 4 or greater had the lowest rate of overtriage. Conclusion: Although the combination of PHI score, HVI presence and EMT judgment offers the highest sensitivity for the identification of patients that could benefit from direct transport to a level-I trauma centre, overall sensitivity remains low and overtriage is high. More research is required to improve prehospital triage. Keywords: trauma, triage, prehospital, emergency medical system, emergency medical technician, ambulance, injury severity Objectif : Nous avons cherche a evaluer la performance de l'indice prehospitalier (IPH) et de la determination de la presence d'un impact a haute velocite (IHV) ainsi que la contribution du jugement du technicien ambulancier lors du triage prehospitalier de patients traumatises. Methodes : La population etudiee incluait tous les patients traumatises en prehospitalier transportes par un service medical d'urgence a 2 centres de traumatologie de niveau I pour adultes. Toutes les donnees recueillies en prehospitalier ont ete liees a celles du registre des traumatismes. Les principales mesures de resultats etaient un traumatisme grave, defini comme un traumatisme entramant la mort dans les 72 heures, l'admission a l'unite de soins intensifs dans les 24 heures ou un indice de gravite de la blessure superieur a 15. Nous avons evalue la sensibilite, la specificite et les taux de surtriage. Resultats : Parmi les 16 805 patients de la population etudiee, 1113 (6,62 %) avaient subi un traumatisme grave. La combinaison des 3 criteres de tri (score de l'IPH [greater than or equal to] 4, presence d'un IHV et jugement du technicien ambulancier) a donne les meilleurs resultats pour depister les patients victimes de traumatismes graves, avec une sensibilite de 74,2 %, mais un taux de surtriage de 85,1 %. Seul, le jugement du technicien ambulancier affichait la plus haute sensibilite, et un score IPH de 4 ou plus donnait le plus faible taux de surtriage. Conclusion : Bien que la combinaison IPH, presence d'un IHV et jugement du technicien ambulancier offre la plus grande sensibilite pour le depistage de patients qui pourraient beneficier du transport direct a un centre de traumatologie de niveau I, la sensibilite globale demeure faible et le surtriage eleve. Il faut entreprendre d'autres recherches pour ameliorer le triage prehospitalier.
INTRODUCTION Trauma is the leading cause of death for people aged 1-45 years in Canada (1) and in the United States. (2) There is strong evidence that regionalized trauma systems [...]