TY - JOUR
T1 - Prospective Validation of the National Field Triage Guidelines for Identifying Seriously Injured Persons
AU - Newgard, Craig D.
AU - Fu, Rongwei
AU - Zive, Dana
AU - Rea, Tom
AU - Malveau, Susan
AU - Daya, Mohamud
AU - Jui, Jonathan
AU - Griffiths, Denise E.
AU - Wittwer, Lynn
AU - Sahni, Ritu
AU - Gubler, K. Dean
AU - Chin, Jonathan
AU - Klotz, Pat
AU - Somerville, Stephanie
AU - Beeler, Tina
AU - Bishop, T. J.
AU - Garland, Tara N.
AU - Bulger, Eileen
N1 - Funding Information:
Support: This project was supported by the National Center for Injury Prevention and Control, Centers for Disease Control and Prevention, grant R01CE001837. The sponsor was not involved in the design and conduct of the study; collection, management, analysis, or interpretation of the data; preparation, review, or approval of the manuscript; or the decision to submit the manuscript for publication.
Funding Information:
This project was supported by the National Center for Injury Prevention and Control, Centers for Disease Control and Prevention, grant R01CE001837. The sponsor was not involved in the design and conduct of the study; collection, management, analysis, or interpretation of the data; preparation, review, or approval of the manuscript; or the decision to submit the manuscript for publication. The authors acknowledge and thank all of the participating EMS agencies, EMS medical directors, hospitals, trauma centers, trauma coordinators, and trauma registrars that supported and helped provide data for this project. The authors also want to acknowledge the guidance and oversight by Study Advisory Committee members: Jerris Hedges, MD, MS; Gregory J Jurkovich, MD; Nathan Kuppermann, MD, MPH; E Brooke Lerner, PhD; and N Clay Mann, PhD, MS.
Publisher Copyright:
© 2016 American College of Surgeons.
PY - 2016/2/1
Y1 - 2016/2/1
N2 - Background The national field trauma triage guidelines have been widely implemented in US trauma systems, but never prospectively validated. We sought to prospectively validate the guidelines, as applied by out-of-hospital providers, for identifying high-risk trauma patients. Study Design This was an out-of-hospital prospective cohort study from January 1, 2011 through December 31, 2011 with 44 Emergency Medical Services agencies in 7 counties in 2 states. We enrolled injured patients transported to 28 acute care hospitals, including 7 major trauma centers (Level I and II trauma hospitals) and 21 nontrauma hospitals. The primary exposure term was Emergency Medical Services' use of one or more field triage criteria in the national field triage guidelines. Outcomes included Injured Severity Score ≥16 (primary) and critical resource use within 24 hours of emergency department arrival (secondary). Results We enrolled 53,487 injured children and adults transported by Emergency Medical Services to an acute care hospital, 17,633 of which were sampled for the primary analysis; 13.9% met field triage guidelines, 3.1% had Injury Severity Score ≥16, and 1.7% required early critical resources. The sensitivity and specificity of the field triage guidelines were 66.2% (95% CI, 60.2-71.7%) and 87.8% (95% CI, 87.7-88.0%) for Injury Severity Score ≥16 and 80.1% (95% CI, 65.8-89.4%) and 87.3% (95% CI 87.1-87.4%) for early critical resource use. Triage guideline sensitivity decreased with age, from 87.4% in children to 51.8% in older adults. Conclusions The national field triage guidelines are relatively insensitive for identifying seriously injured patients and patients requiring early critical interventions, particularly among older adults.
AB - Background The national field trauma triage guidelines have been widely implemented in US trauma systems, but never prospectively validated. We sought to prospectively validate the guidelines, as applied by out-of-hospital providers, for identifying high-risk trauma patients. Study Design This was an out-of-hospital prospective cohort study from January 1, 2011 through December 31, 2011 with 44 Emergency Medical Services agencies in 7 counties in 2 states. We enrolled injured patients transported to 28 acute care hospitals, including 7 major trauma centers (Level I and II trauma hospitals) and 21 nontrauma hospitals. The primary exposure term was Emergency Medical Services' use of one or more field triage criteria in the national field triage guidelines. Outcomes included Injured Severity Score ≥16 (primary) and critical resource use within 24 hours of emergency department arrival (secondary). Results We enrolled 53,487 injured children and adults transported by Emergency Medical Services to an acute care hospital, 17,633 of which were sampled for the primary analysis; 13.9% met field triage guidelines, 3.1% had Injury Severity Score ≥16, and 1.7% required early critical resources. The sensitivity and specificity of the field triage guidelines were 66.2% (95% CI, 60.2-71.7%) and 87.8% (95% CI, 87.7-88.0%) for Injury Severity Score ≥16 and 80.1% (95% CI, 65.8-89.4%) and 87.3% (95% CI 87.1-87.4%) for early critical resource use. Triage guideline sensitivity decreased with age, from 87.4% in children to 51.8% in older adults. Conclusions The national field triage guidelines are relatively insensitive for identifying seriously injured patients and patients requiring early critical interventions, particularly among older adults.
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U2 - 10.1016/j.jamcollsurg.2015.10.016
DO - 10.1016/j.jamcollsurg.2015.10.016
M3 - Article
C2 - 26712244
AN - SCOPUS:84959472175
SN - 1072-7515
VL - 222
SP - 146-158.e2
JO - Surgery Gynecology and Obstetrics
JF - Surgery Gynecology and Obstetrics
IS - 2
ER -