Accuracy of Prehospital Triage of Adult Patients With Traumatic Injuries Following Implementation of a Trauma Triage Intervention

Key Points Question Was the implementation of the trauma triage intervention associated with a change in prehospital triage among adult patients with traumatic injuries? Findings In this quality improvement study including 80738 adult patients with traumatic injuries, the implementation of a trauma triage intervention with an application was associated with a statistically significantly lower adjusted risk for undertriage; the adjusted risk for overtriage was unchanged after the intervention. Meaning This quality improvement study found that implementation of the trauma triage intervention was associated with improved rates of undertriage. This quality improvement study evaluates the association between the implementation of the trauma triage (TT) intervention app and prehospital mistriage among adult patients with trauma. Importance Adequate prehospital triage is pivotal to enable optimal care in inclusive trauma systems and reduce avoidable mortality, lifelong disabilities, and costs. A model has been developed to improve the prehospital allocation of patients with traumatic injuries and was incorporated in an application (app) to be implemented in prehospital practice. ObjectiveTo evaluate the association between the implementation of a trauma triage (TT) intervention with an app and prehospital mistriage among adult trauma patients. Design, Setting, and Participants This population-based, prospective quality improvement study was conducted in 3 of the 11 Dutch trauma regions (27.3%), with full coverage of the corresponding emergency medical services (EMS) regions participating in this study. Participants included adult patients (age >= 16 years) with traumatic injuries who were transported by ambulance between February 1, 2015, and October 31, 2019, from the scene of injury to any emergency department in the participating trauma regions. Data were analyzed between July 2020 and June 2021. Exposures Implementation of the TT app and the awareness of need for adequate triage created by its implementation (ie, the TT intervention). Main Outcomes and Measures The primary outcome was prehospital mistriage, evaluated in terms of undertriage and overtriage. Undertriage was defined as the proportion of patients with an Injury Severity Score (ISS) of 16 or greater who were initially transported to a lower-level trauma center (designated to treat patients who are mildly and moderately injured) and overtriage as the proportion of patients with an ISS of less than 16 who were initially transported to a higher-level trauma center (designated to treat patients who are severely injured). Results A total of 80738 patients were included (40427 [50.1%] before and 40311 [49.9%] after implementation of the intervention), with a median (IQR) age of 63.2 (40.0-79.7) years and 40132 (49.7%) male patients. Undertriage decreased from 370 of 1163 patients (31.8%) to 267 of 995 patients (26.8%), while overtriage rates did not increase (8202 of 39264 patients [20.9%] vs 8039 of 39316 patients [20.4%]). The implementation of the intervention was associated with a statistically significantly reduced risk for undertriage (crude risk ratio [RR], 0.95; 95% CI, 0.92 to 0.99, P=.01; adjusted RR, 0.85; 95% CI, 0.76-0.95; P=.004), but the risk for overtriage was unchanged (crude RR, 1.00; 95% CI, 0.99-1.00; P=.13; adjusted RR, 1.01; 95% CI, 0.98-1.03; P=.49). Conclusions and Relevance In this quality improvement study, implementation of the TT intervention was associated with improvements in rates of undertriage. Further research is needed to assess whether these findings are generalizable to other trauma systems.