Background
1) admission from external hospital | ||
---|---|---|
2) injury mechanism | 3) anatomic criteria | 4) physiological criteria |
proximal gunshot/stab wound | open thoracic injury | intubation |
pedestrian vs. vehicle | unstable thorax injury | respiratory deficiency |
passenger in vehicle: velocity ≥ 50 km/h or car body deformation ≥ 50 cm | severe abdominal injury | respiratory frequency < 10 or > 30/min |
ejection from a vehicle | unstable pelvis fracture | SaO2 < 90% |
death of a vehicle passenger | proximal amputation | systolic blood pressure < 90 mmHg |
collision with rail vehicle | proximal vessel injury | GCS < 14 |
fall from ≥ 3 m | > 1 long bone fracture | |
explosion | moderate/severe head injury | |
entombment |
Methods
Study design
Study setting
ERTTAC
Scoring
Over- and undertriage and attribution rates
Statistics
Results
Over- and Undertriage
cases in the ER | cases not in the ER | |||||
---|---|---|---|---|---|---|
ISS ≤ 15 | ISS > 15 | ISS > 15 | ||||
(n = 1378) | (n = 1052) | (n = 326) | (n = 80) | |||
Mean ± SD | Mean ± SD | Mean ± SD |
p
| Mean ± SD |
p
| |
N (%) | N (%) | N (%) | N (%) | |||
male | 879 (63.8%) | 658 (62.5%) | 221 (67.8%) | 0.09 | 48 (60%) | 0.20 |
female | 499 (36.2%) | 394 (37.5%) | 105 (32.2%) | 32 (40%) | ||
age at accident (years) | 48.3 ± 21.2 | 45.7 ± 20.4 | 56.6 ± 21.6 | < 0.001 | 68.7 ± 19.1 | < 0.001 |
ISS | 9.7 ± 9.6 | 5.3 ± 4.3 | 23.9 ± 7.9 | < 0.001 | 20.3 ± 4.5 | < 0.001 |
NISS | 12.5 ± 12.3 | 7.1 ± 6.5 | 29.7 ± 11 | < 0.001 | 25.4 ± 7.2 | 0.001 |
AIS1 | 1.3 ± 1.5 | 0.9 ± 1 | 2.7 ± 1.8 | < 0.001 | 3.7 ± 1.3 | < 0.001 |
AIS2 | 0.2 ± 0.6 | 0.1 ± 0.5 | 0.5 ± 0.9 | < 0.001 | 0.5 ± 0.9 | 0.99 |
AIS3 | 0.8 ± 1.3 | 0.4 ± 0.9 | 1.9 ± 1.6 | < 0.001 | 0.6 ± 1.2 | < 0.001 |
AIS4 | 0.4 ± 0.9 | 0.2 ± 0.6 | 0.9 ± 1.3 | < 0.001 | 0.2 ± 0.6 | < 0.001 |
AIS5 | 0.8 ± 1.2 | 0.5 ± 1 | 1.4 ± 1.4 | < 0.001 | 0.7 ± 1.1 | < 0.001 |
AIS6 | 0.6 ± 0.6 | 0.6 ± 0.5 | 0.4 ± 0.7 | < 0.001 | 0.3 ± 0.4 | 0.03 |
1st GCS | 13.3 ± 3.4 | 14 ± 2.5 | 11.1 ± 4.7 | < 0.001 | 13.8 ± 2.1 | < 0.001 |
lowest SaO2 (%) | 94.1 ± 10.1 | 94.5 ± 10.2 | 92.9 ± 9.6 | 0.06 | 93.3 ± 5.3 | 0.85 |
lowest systolic BP (mmHg) | 133 ± 28 | 134.6 ± 27 | 128.2 ± 30.5 | 0.004 | 136 ± 21.7 | 0.20 |
RISC (%) | 7.7 ± 16.8 | 3.1 ± 5.9 | 22.4 ± 28.3 | < 0.001 | 22.8 ± 20 | 0.90 |
hospital mortality | 96 (7%) | 17 (1.6%) | 79 (24.2%) | < 0.001 | 7 (8.8%) | 0.002 |
Simulation models
ERTTAC | ISS ≤ 15 | ISS > 15 | total |
P
| over-triage | under-triage | |
---|---|---|---|---|---|---|---|
trauma patients treated in the ER | N | 1052 | 326 | 1378 | |||
% | 76.3% | 23.7% | 100.0% | ||||
Transfer criterion | |||||||
transfer from external hospital | no | 936 | 253 | 1189 | < 0.001 | 116/1052 | 253/326 |
yes | 116 | 73 | 189 | 11.0% | 77.6% | ||
% | 11.0% | 22.4% | 13.7% | ||||
Mechanism of injury | |||||||
mechanism of injury (traffic) | no | 513 | 199 | 712 | < 0.001 | 539/1052 | 199/326 |
yes | 539 | 127 | 666 | 51.2% | 61.0% | ||
%
| 51.2% | 39.0% | 48.3% | ||||
mechanism of injury (car /truck passenger only) | no | 726 | 288 | 1014 | < 0.001 | 326/1052 | 288/326 |
yes | 326 | 38 | 364 | 31.0% | 88.3% | ||
% | 31.0% | 11.7% | 26.4% | ||||
mechanism of injury (traffic, except car /truck passenger) | no | 839 | 237 | 1076 | 0.008 | 213/1052 | 237/326 |
yes | 213 | 89 | 302 | 20.2% | 72.7% | ||
% | 20.2% | 27.3% | 21.9% | ||||
fall from height ≥ 3 m | no | 921 | 267 | 1188 | 0.01 | 131/1052 | 267/326 |
yes | 131 | 59 | 190 | 12.5% | 81.9% | ||
% | 12.5% | 18.1% | 13.8% | ||||
penetrating injury (chest, abdomen) | no | 1020 | 314 | 1334 | 0.56 | 32/1052 | 314/326 |
yes | 32 | 12 | 44 | 3.0% | 96.3% | ||
% | 3.0% | 3.7% | 3.2% | ||||
Combined mechanism of injury | |||||||
mechanism of injury (penetrating, traffic, fall ≥ 3 m) | no | 352 | 130 | 482 | 0.034 | 700/1052 | 130/326 |
yes | 700 | 196 | 896 | 66.5% | 39.9% | ||
% | 66.5% | 60.1% | 65.0% | ||||
mechanism of injury without car criteria (penetrating, traffic, fall ≥ 3 m) | no | 677 | 168 | 845 | < 0.001 | 375/1052 | 168/326 |
yes | 375 | 158 | 533 | 35.6% | 51.5% | ||
% | 35.6% | 48.5% | 38.7% | ||||
Anatomic criterion | |||||||
EMS injury | no | 882 | 194 | 1076 | < 0.001 | 170/1052 | 194/326 |
yes | 170 | 132 | 302 | 16.2% | 59.5% | ||
% | 16.2% | 40.5% | 21.9% | ||||
Physiological criteria | |||||||
Intubation before arrival in ER | no | 1003 | 235 | 1238 | < 0.001 | 49/1052 | 235/326 |
yes | 49 | 91 | 140 | 4.7% | 72.1% | ||
% | 4.7% | 27.9% | 10.2% | ||||
intubation in ER | no | 1025 | 285 | 1310 | < 0.001 | 27/1052 | 285/326 |
yes | 27 | 41 | 68 | 2.6% | 87.4% | ||
% | 2.6% | 12.6% | 4.9% | ||||
SaO2 < 90% | no | 981 | 282 | 1263 | < 0.001 | 71/1052 | 282/326 |
yes | 71 | 44 | 115 | 6.7% | 86.5% | ||
% | 6.7% | 13.5% | 8.3% | ||||
systolic (BP < 90 mmHg) | no | 1028 | 310 | 1338 | 0.02 | 24/1052 | 310/326 |
yes | 24 | 16 | 40 | 2.3% | 95.1% | ||
% | 2.3% | 4.9% | 2.9% | ||||
1st GCS < 14 | no | 897 | 178 | 1075 | < 0.001 | 155/1052 | 178/326 |
yes | 155 | 148 | 303 | 14.7% | 54.6% | ||
% | 14.7% | 45.4% | 22.0% | ||||
1st GCS < 9 | no | 992 | 236 | 1228 | < 0.001 | 60/1052 | 236/326 |
yes | 60 | 90 | 150 | 5.7% | 72.4% | ||
% | 5.7% | 27.6% | 10.9% | ||||
Combined physiological criteria | |||||||
physiological criteria (1st GCS < 14, intubation, SaO2 < 90%, BP < 90 mmHg) | no | 821 | 136 | 957 | < 0.001 | 231/1052 | 136/326 |
yes | 231 | 190 | 421 | 22.0% | 41.7% | ||
% | 22.0% | 58.3% | 30.6% | ||||
physiological criteria (1st GCS < 9, intubation, SaO2 < 90%, BP < 90 mmHg) | no | 888 | 164 | 1052 | < 0.001 | 164/1052 | 164/326 |
yes | 164 | 162 | 326 | 15.6% | 50.3% | ||
% | 15.6% | 49.7% | 23.7% | ||||
Overall combined criteria | |||||||
all criteria: 1st GCS < 14 | no | 139 | 15 | 154 | < 0.001 | 913/1052 | 15/326 |
yes | 913 | 311 | 1224 | 86.8% | 4.6% | ||
% | 86.8% | 95.4% | 88.8% | ||||
all criteria: 1st GCS < 9 | no | 167 | 24 | 191 | < 0.001 | 885/1052 | 24/326 |
yes | 885 | 302 | 1187 | 84.1% | 7.4% | ||
% | 84.1% | 92.6% | 86.1% | ||||
all criteria: 1st GCS < 14; without car criteria | no | 396 | 23 | 419 | < 0.001 | 656/1052 | 23/326 |
yes | 656 | 303 | 959 | 62.4% | 7.1% | ||
% | 62.4% | 92.9% | 69.6% | ||||
all criteria: 1st GCS < 9; without car criteria | no | 430 | 35 | 465 | < 0.001 | 622/1052 | 35/326 |
yes | 622 | 291 | 913 | 59.1% | 10.7% | ||
% | 59.1% | 89.3% | 66.3% |