Evaluation of pre-hospital trauma triage criteria: a prospective study at a Danish level I trauma centre

Background: The aim of the present study was to evaluate the precision of our trauma triage protocol [based on the American College of Surgeons, Committee on Trauma (ACS COT)] in identifying severely injured defined as an injury severity score (ISS) > 15. Our hypothesis was that isolated mechanism‐of‐injury criteria were responsible for a significant over‐triage leading to over‐use of our trauma team. Methods: Design: A prospective cohort study. Setting: A level I trauma centre, Aarhus, Denmark. Patients and participants: Among all injured patients admitted during a 6‐month period in 2003 we identified severely injured. During the study period, trauma team activations were consecutively registered and triage criteria were prospectively collected. Sensitivity, specificity, positive predictive value, over‐triage and under‐triage were calculated. Results: Out of 15,162 patients in the emergency department, 848 injured patients were included and 59 (7%) were severely injured. We had 242 trauma team activations with 54 (22%) severely injured. Sensitivity was 92%, specificity 76%, giving an over‐triage of 24% and an under‐triage of 8%. The positive predictive value was 22%. Among 60 patients with mechanism‐of‐injury as the only criterion, five were severely injured in contrast to 12 out of 20 patients with mechanism‐of‐injury combined with physiological and/or anatomical criteria. Conclusion: The positive predictive value of our triage protocol was low, only 22%. This was mainly as a result of a significant over‐triage from isolated mechanism‐of‐injury criteria. We recommend revision of the triage protocol and reallocation of our trauma team resources.