Priority accuracy by dispatch centers and Emergency Medical Services professionals in trauma patients: a cohort study

Job F. Waalwijk*, Robin D. Lokerman, Rogier van der Sluijs, Audrey A.A. Fiddelers, Luke P.H. Leenen, Mark van Heijl, Martijn Poeze, the Pre-hospital Trauma Triage Research Collaborative (PTTRC)

*Corresponding author for this work

Research output: Contribution to journalArticleAcademicpeer-review

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Abstract

Purpose: Priority-setting by dispatch centers and Emergency Medical Services professionals has a major impact on pre-hospital triage and times of trauma patients. Patients requiring specialized care benefit from expedited transport to higher-level trauma centers, while transportation of these patients to lower-level trauma centers is associated with higher mortality rates. This study aims to evaluate the accuracy of priority-setting by dispatch centers and Emergency Medical Services professionals. Methods: This observational study included trauma patients transported from the scene of injury to a trauma center. Priority-setting was evaluated in terms of the proportion of patients requiring specialized trauma care assigned with the highest priority (i.e., sensitivity), undertriage, and overtriage. Patients in need of specialized care were defined by a composite resource-based endpoint. An Injury Severity Score ≥ 16 served as a secondary reference standard. Results: Between January 2015 and December 2017, records of 114,459 trauma patients were collected, of which 3327 (2.9%) patients were in need of specialized care according to the primary reference standard. Dispatch centers and Emergency Medical Services professionals assigned 83.8% and 74.5% of these patients with the highest priority, respectively. Undertriage rates ranged between 22.7 and 65.5% in the different prioritization subgroups. There were differences between dispatch and transport priorities in 17.7% of the patients. Conclusion: The majority of patients that required specialized care were assigned with the highest priority by the dispatch centers and Emergency Medical Services professionals. Highly accurate priority criteria could improve the quality of pre-hospital triage.

Original languageEnglish
Pages (from-to)1111-1120
Number of pages10
JournalEuropean Journal of Trauma and Emergency Surgery
Volume48
Issue number2
DOIs
Publication statusPublished - Apr 2022

Bibliographical note

Funding Information:
This study was partly funded by grants from the Netherlands Organisation for Health Research and Development (ZonMw; 80-84300-98-18555) and the Innovation Fund Health Insurers (3383).

Publisher Copyright: © 2021, The Author(s).

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