Prehospital triage of trauma patients before and after implementation of a regional triage guideline

Joachim Hansen; Lars Simon Rasmussen; Jacob Steinmetz

doi:10.1016/j.injury.2021.10.011

Prehospital triage of trauma patients before and after implementation of a regional triage guideline

Injury. 2022 Jan;53(1):54-60. doi: 10.1016/j.injury.2021.10.011. Epub 2021 Oct 14.

Authors

Joachim Hansen¹, Lars Simon Rasmussen², Jacob Steinmetz³

Affiliations

¹ Department of Anesthesia and Trauma Centre, Centre of Head and Orthopedics, Rigshospitalet, University of Copenhagen, Inge Lehmanns Vej 6, Section 6011, Copenhagen DK-2100, Denmark. Electronic address: Joachim.hansen.01@regionh.dk.
² Department of Anesthesia and Trauma Centre, Centre of Head and Orthopedics, Rigshospitalet, University of Copenhagen, Inge Lehmanns Vej 6, Section 6011, Copenhagen DK-2100, Denmark; Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark.
³ Department of Anesthesia and Trauma Centre, Centre of Head and Orthopedics, Rigshospitalet, University of Copenhagen, Inge Lehmanns Vej 6, Section 6011, Copenhagen DK-2100, Denmark; The Danish Air Ambulance, Aarhus, Denmark.

PMID: 34711398
DOI: 10.1016/j.injury.2021.10.011

Abstract

Introduction: Severely injured trauma patients have a considerable mortality rate. One way to reduce the mortality is to ensure optimal triage. The American College of Surgeons Committee on Trauma has since 1986 made guidelines for the triage of trauma patients. These guidelines formed the basis, when the capital region of Denmark implemented a regional trauma triage guideline on February 15th 2016. It is uncertain how the implementation of the regional trauma triage guideline has influenced the triage of trauma patients. The aim of this study was to investigate the changes in admission pattern of trauma patients in the entire region after the implementation of the regional trauma triage guideline. We hypothesized that there would be a reduction in the proportion of trauma patients admitted to the trauma center after the implementation of the regional trauma triage guideline.

Patients and methods: In this observational cohort study with one-year follow-up, we used a national patient registry in Denmark. We identified trauma patients three years before and three years after the implementation of a new regional trauma triage guideline. The primary outcome was the proportion of trauma patients triaged to the regional trauma center. Secondary outcomes were: 30-day and one-year mortality, overtriage, and undertriage.

Results: We found a significant reduction in the proportion of trauma patients triaged to the trauma center from 2115/5951 (35.5%) to 1970/5857 (33.6%), after the implementation of the regional trauma triage guideline, the difference being 1.9% (95% CI: 0.19 to 3.6%); P = 0.03. Further, a significant reduction of overtriage from 15.4% to 9.5% (difference 5.9% with 95% CI of 3.8 to 7.9%) was found. No significant changes in undertriage, 30-day or one-year mortality were found (1.07% vs 0.97%, 4.3% vs 4.5%, and 15.7% vs 16.6% respectively).

Conclusion: A significant decrease in the proportion of trauma patients admitted to the trauma center was found after implementation of a new regional trauma triage guideline. A reduction was seen in overtriage, but no changes were found in undertriage and both short-term and long-term mortality remained unchanged.

Keywords: Guideline; Overtriage; Regional trauma system; Trauma; Triage; Undertriage.

Publication types

Observational Study

MeSH terms

Humans
Retrospective Studies
Trauma Centers
Triage*
Wounds and Injuries* / therapy