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Field Trauma Triage Criteria Associated with need for Dedicated Trauma Center Care: A Single Center Health Records Study
Introduction
Direct transport from the scene of injury to a trauma centre reduces morbidity and mortality for severely injured patients. In Ontario, paramedics use the field trauma triage standard (FTTS) to determine if a patient meets trauma bypass criteria. Recent studies have questioned the efficacy of the FTTS in identifying severely injured patients. The objective of this study was to determine the predictive performance of the FTTS on the need for trauma center care in patients who were transported to a trauma center.
Methods
This was a single center health records study of patients transported by ambulance directly to a level 1 trauma center. Hospital based trauma center need (HBTCN) and injury severity score-based trauma center (ISSTCN) were defined. Bivariate associations with one or more FTTS criteria were tested using the Wilcoxon two sample test for continuous variables, and the chi-square or Fisher’s exact test for categorical indicators. The sensitivity and specificity of each category of the FTTS were calculated.
Results
There were 1427 patients included in the study, with 76% men, mean age of 40, and 76% had a blunt mechanism. The overall sensitivity and specificity of the FTTS was 90.9% and 20.8% for HBTCN and 91.6% and 20.3 for ISSTCN. The most sensitive variable for HBTCN was physiologic criteria (53.7). Mechanism of injury was the most sensitive criteria for ISSTCN (54.8). Physiological criteria had the highest association with HBTCN and ISSTCN (adjusted odds ratios 7.5 [95% CI 5.8-9.8] and 5.1 [95% CI 3.9-6.7]).
Conclusion
The FTTS has fair performance in identifying the need for hospital-based and ISS-based trauma centre need. Systolic blood pressure less than 90mmHg, Glasgow Coma Scale (Motor) less than 6, and falls greater than 6m were more predictive of HBTCN. Improving prehospital trauma triage is critical to ensure timely transport to a trauma centre.
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