Evaluating pre-hospital triage and decision-making in patients who died within 30 days post-trauma: A multi-site, multi-center, cohort study

Robin D Lokerman*, Job F Waalwijk, Rogier van der Sluijs, Roderick M Houwert, Luke P H Leenen, Mark van Heijl, Pre-hospital Trauma Triage Research Collaborative

*Corresponding author for this work

Research output: Contribution to journalArticleAcademicpeer-review

Abstract

INTRODUCTION: Evaluating pre-hospital triage and decision-making in patients who died post-trauma is crucial to decrease undertriage and improve future patients' chances of survival. A study that has adequately investigated this is currently lacking. The aim of this study was therefore to evaluate pre-hospital triage and decision-making in patients who died within 30 days post-trauma.

MATERIALS AND METHODS: A multi-site, multi-center, cohort study was conducted. Trauma patients who were transported from the scene of injury to a trauma center by ambulance and died within 30 days post-trauma, were included. The main outcome was undertriage, defined as erroneously transporting a severely injured patient (Injury Severity Score ≥ 16) to a lower-level trauma center.

RESULTS: Between January 2015 and December 2017, 2116 patients were included, of whom 765 (36.2%) were severely injured. A total of 103 of these patients (13.5%) were undertriaged. Undertriaged patients were often elderly with a severe head and/or thoracic injury as a result of a minor fall (< 2 m). A majority of the undertriaged patients were triaged without assistance of a specialized physician (100 [97.1%]), did not meet field triage criteria for level-I trauma care (81 [78.6%]), and could have been transported to the nearest level-I trauma center within 45 min (93 [90.3%]).

CONCLUSION: Approximately 14% of the severely injured patients who died within 30 days were undertriaged and could have benefited from treatment at a level-I trauma center (i.e., specialized trauma care). Improvement of pre-hospital triage is needed to potentially increase future patients' chances of survival.

Original languageEnglish
Pages (from-to)1699-1706
Number of pages8
JournalInjury-International Journal of the Care of the Injured
Volume53
Issue number5
Early online date4 Mar 2022
DOIs
Publication statusPublished - May 2022

Keywords

  • ACCURACY
  • CARE
  • Death
  • EMS
  • FIELD TRIAGE
  • GOLDEN HOUR
  • INJURED PATIENTS
  • LEVEL I
  • Mortality
  • OUTCOMES
  • Pre-hospital
  • TIME
  • TRAUMA PATIENTS
  • Trauma
  • Triage

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