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Association between updated 2021 Field Trauma Triage Standard and need for trauma center care: A single center retrospective cohort study
Introduction and Objective: The Field Trauma Triage Standard (FTTS), established by the American College of Surgeons, were updated in 2021 to improve adherence and accuracy of prehospital triage. The guidelines separate patient characteristics into either High Risk for Serious Injury Red Criteria or Moderate Risk for Serious Injury Yellow Criteria. This study assessed the proportion of patients triaged to a Level 1 trauma center that met revised criteria and their association with need for trauma center care.
Methods: A retrospective cohort study of FTTS criteria met for trauma team activations at a Level 1 trauma center from January to October 2020. Interfacility transfers or patients not brought to hospital by paramedics were excluded. Descriptive statistics were calculated for specific FTTS criteria and injury-based trauma centre need (TCN), defined as injury severity score (ISS) above 15.
Results: A total of 532 patients met the inclusion criteria with a median age of 39 (IQR 27-57), 75% being male, and a median ISS of 9 (IQR 1-17). Overall, 484 (91%) patients met at least one of the new FTTS criteria and 154 (29%) had an ISS above 15.
Red Criteria: 223 (42%) of patients met at least one of the mental status and vital signs changes criteria, with 105 (47%) of those patients having an ISS > 15. 248 (47%) met at least one of the injury pattern criteria, with 85 (34%) of those having an ISS > 15.
Yellow Criteria: 218 (41%) of patients met at least one of the mechanism of injury criteria, with 84 (39%) of those patients having as ISS > 15. 49 (9%) of patients met the EMS judgement criteria, with 9 (18%) of those having an ISS > 15.
Criteria most associated with TCN include motor GCS <6 (42%), systolic blood pressure (SBP) less than 90mmHg in 10-64 age group (27%), respiratory distress (25%), and HR > SBP in 10-64 age group (23%).
Conclusion: Patients meeting Red Criteria were more likely to meet TCN (ISS>15). EMS judgement was least associated with injury-based TCN. Future work should include a comparison of these revised guidelines with the current FTTS prior to adoption into practice.
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