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Evaluation of the Prehospital Index, presence of high-velocity impact and judgment of emergency medical technicians as criteria for trauma triage

Published online by Cambridge University Press:  21 May 2015

Andre Lavoie ,
Marcel Émond ,
Lynne Moore ,
Stéphanie Camden  and
Moishe Liberman
Andre Lavoie*
Affiliation:
Unité de recherche en traumatologie-urgence-soins intensifs, Centre de recherche du CHA (Hôpital de l'Enfant-Jésus), Québec City, Que. Département de médecine sociale et préventive, Université Laval, Québec City, Que.
Marcel Émond
Affiliation:
Unité de recherche en traumatologie-urgence-soins intensifs, Centre de recherche du CHA (Hôpital de l'Enfant-Jésus), Québec City, Que. Départment de médecine familliale – section médecine d'urgence, Université Laval, Québec City, Que.
Lynne Moore
Affiliation:
Unité de recherche en traumatologie-urgence-soins intensifs, Centre de recherche du CHA (Hôpital de l'Enfant-Jésus), Québec City, Que. Département de médecine sociale et préventive, Université Laval, Québec City, Que.
Stéphanie Camden
Affiliation:
Unité de recherche en santé des populations, Centre de recherche du CHA, Québec City, Que.
Moishe Liberman
Affiliation:
Division de chirurgie thoracique, Centre hospitalier universitaire de Montréal (Hôpital Notre-Dame), Montréal, Que.
*
Centre de recherche du CHA (Hôpital de l’Enfant-Jésus), Unité de recherche en traumatologiemédecine d'urgence-soins intensifs, 1401 18e rue, Québec City QCG1J 1Z4; andre.lavoie.trauma.cha@ssss.gouv.qc.ca

Abstract

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Objective:

We sought to evaluate the performance of the Prehospital Index (PHI), the high-velocity impact (HVI) criterion and emergency medical technician (EMT) judgment for the prehospital triage of injured patients.

Methods:

The study population included all prehospital trauma patients transported by an emergency medical service to 2 level-I trauma centres for adults. All prehospital run sheets were linked to trauma registry data. The main outcome was severe trauma, defined as death within 72 hours, admission to the intensive care unit within 24 hours or an Injury Severity Score greater than 15. We assessed sensitivity, specificity and rates of overtriage.

Results:

Of 16 805 patients in the study population, 1113 (6.62%) had severe trauma. The combination of all 3 triage criteria (PHI score ≥ 4, HVI presence and EMT judgment) performed best for identifying patients with severe trauma, with a sensitivity of 74.2% but with an overtriage rate of 85.1%. Alone, EMT judgment had the highest sensitivity and a PHI score of 4 or greater had the lowest rate of overtriage.

Conclusion:

Although the combination of PHI score, HVI presence and EMT judgment offers the highest sensitivity for the identification of patients that could benefit from direct transport to a level-I trauma centre, overall sensitivity remains low and overtriage is high. More research is required to improve prehospital triage.

Keywords

traumatriageprehospitalemergency medical systememergency medical technicianambulanceinjury severity
Type
Original Research • Recherche originale
Information
Canadian Journal of Emergency Medicine , Volume 12 , Issue 2 , March 2010 , pp. 111 - 118
Copyright
Copyright © Canadian Association of Emergency Physicians 2010

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