Eveline A J van Rein1, Rogier van der Sluijs2, R Marijn Houwert3, Amy C Gunning2, Rob A Lichtveld4, Luke P H Leenen2, Mark van Heijl5. 1. Department of Trauma Surgery, University Medical Center Utrecht, Utrecht, The Netherlands. Electronic address: e.a.j.vanrein@umcutrecht.nl. 2. Department of Trauma Surgery, University Medical Center Utrecht, Utrecht, The Netherlands. 3. Utrecht Trauma Center, Utrecht, The Netherlands. 4. Regional Ambulance Facilities Utrecht, RAVU, Utrecht, The Netherlands. 5. Department of Trauma Surgery, University Medical Center Utrecht, Utrecht, The Netherlands; Department of Surgery, Diakonessenhuis, Zeist, Doorn, Utrecht, The Netherlands.
Abstract
INTRODUCTION: In an optimal trauma system, prehospital trauma triage ensures transport of the right patient to the right hospital. Incorrect triage results in undertriage and overtriage. The aim of this systematic review is to evaluate and compare prehospital trauma triage system quality worldwide and determine effectiveness in terms of undertriage and overtriage for trauma patients. METHODS: A systematic search of Pubmed/MEDLINE, Embase, and Cochrane Library databases was performed, using "trauma", "trauma center," or "trauma system", combined with "triage", "undertriage," or "overtriage", as search terms. All studies describing ground transport and actual destination hospital of patients with and without severe injuries, using prehospital triage, published before November 2017, were eligible for inclusion. To assess the quality of these studies, a critical appraisal tool was developed. RESULTS: A total of 33 articles were included. The percentage of undertriage ranged from 1% to 68%; overtriage from 5% to 99%. Older age and increased geographical distance were associated with undertriage. Mortality was lower for severely injured patients transferred to a higher-level trauma center. The majority of the included studies were of poor methodological quality. The studies of good quality showed poor performance of the triage protocol, but additional value of EMS provider judgment in the identification of severely injured patients. CONCLUSION: In most of the evaluated trauma systems, a substantial part of the severely injured patients is not transported to the appropriate level trauma center. Future research should come up with new innovative ways to improve the quality of prehospital triage in trauma patients.
INTRODUCTION: In an optimal trauma system, prehospital trauma triage ensures transport of the right patient to the right hospital. Incorrect triage results in undertriage and overtriage. The aim of this systematic review is to evaluate and compare prehospital trauma triage system quality worldwide and determine effectiveness in terms of undertriage and overtriage for traumapatients. METHODS: A systematic search of Pubmed/MEDLINE, Embase, and Cochrane Library databases was performed, using "trauma", "trauma center," or "trauma system", combined with "triage", "undertriage," or "overtriage", as search terms. All studies describing ground transport and actual destination hospital of patients with and without severe injuries, using prehospital triage, published before November 2017, were eligible for inclusion. To assess the quality of these studies, a critical appraisal tool was developed. RESULTS: A total of 33 articles were included. The percentage of undertriage ranged from 1% to 68%; overtriage from 5% to 99%. Older age and increased geographical distance were associated with undertriage. Mortality was lower for severely injured patients transferred to a higher-level trauma center. The majority of the included studies were of poor methodological quality. The studies of good quality showed poor performance of the triage protocol, but additional value of EMS provider judgment in the identification of severely injured patients. CONCLUSION: In most of the evaluated trauma systems, a substantial part of the severely injured patients is not transported to the appropriate level trauma center. Future research should come up with new innovative ways to improve the quality of prehospital triage in traumapatients.
Authors: Heather R Kregel; Gabrielle E Hatton; Kayla D Isbell; Hanne H Henriksen; Jakob Stensballe; Per I Johansson; Lillian S Kao; Charles E Wade Journal: Shock Date: 2022-01-01 Impact factor: 3.533
Authors: Ellen Ceklic; Hideo Tohira; Stephen Ball; Elizabeth Brown; Deon Brink; Paul Bailey; Rudolph Brits; Judith Finn Journal: BMC Emerg Med Date: 2022-05-06
Authors: Suzan Dijkink; Erik W van Zwet; Pieta Krijnen; Luke P H Leenen; Frank W Bloemers; Michael J R Edwards; Dennis Den Hartog; Peter A Leenhouts; Martijn Poeze; W Richard Spanjersberg; Klaus W Wendt; Ralph J De Wit; Stefan W A M Van Zuthpen; Inger B Schipper Journal: Eur J Trauma Emerg Surg Date: 2021-03-12 Impact factor: 3.693