TY  - JOUR
PY  - 2015//
TI  - A regional trauma system to optimize the pre-hospital triage of trauma patients
JO  - Critical care : the Official Journal of the Critical Care Forum
A1  - Bouzat, Pierre
A1  - Ageron, François-Xavier
A1  - Brun, Julien
A1  - Levrat, Albrice
A1  - Berthet, Marion
A1  - Rancurel, Elisabeth
A1  - Thouret, Jean-Marc
A1  - Thony, Frederic
A1  - Arvieux, Catherine
A1  - Payen, Jean-François
SP  - 111
EP  - 111
VL  - 19
IS  - 1
N2  - INTRODUCTION: Pre-hospital triage is a key element in a trauma system that aims to admit patients to the most suitable trauma centre, 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. <br><br>METHODS: Our regional trauma system included 13 hospitals categorized as Level I, II or III trauma centres 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 centres. This study is a registry analysis of a three-year period (2009 to 2011). <br><br>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). <br><br>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.<p />  <p>Language: en</p>
LA  - en
SN  - 1364-8535
UR  - http://dx.doi.org/10.1186/s13054-015-0835-7
ID  - ref1
ER  -