Sensitivity and specificity of a triage score dedicated to trauma patients in a tertiary-level hospital: preliminary results

Introduction

The aim of the study was to determine the sensitivity and specificity of the triage criteria adopted for multiple trauma patients in order to activate the Trauma Team in our tertiary-level trauma centre.

Methods

A cohort study. Between 1 September and 30 November 2006, all trauma patients admitted to the ED triaged red, yellow or green on admission and discharged as a red code from the ED following specific criteria were included. Triage criteria on admission included at least one of the following: GCS < 13, systolic BP > 220 and < 100 mmHg, SaO₂ < 95% on oxygen 100% or intubated; clinical signs: penetrating wounds, spinal injury, sternal or flail chest, two long-bone fractures, proximal crash or amputation of limbs, post-traumatic seizures at any time, signs of fracture of the skull; major accident mechanics: fatality in the same vehicle, fall from a height >3 m, prolonged extrication time (>20 min), pedestrian hit by a car, ejection, explosion in a close environment. Severely injured patients at discharge from the ED were defined by: invasive resuscitating procedures (that is, tracheal intubation), invasive life-saving procedures (emergency surgery, defibrillation) and need for admission to the ICU. Sensitivity and specificity of the triage criteria assigned on admission were calculated and compared with the patients that were triaged red at discharge from ED.

Results

During the time span, 5,142 trauma patients were admitted to the ED: 4,884 were triaged green, 182 yellow and 76 were triaged as red. Of the 76 red on admission, 55 patients fulfilled the abovementioned criteria and were confirmed severely injured at discharge from ED. Out of the 55, 53 patients were correctly identified by triage criteria, while two patients were missed. The sensitivity is 96%. Out of the 76 triaged red on admission, 53 patients were confirmed at discharge from ED. The specificity is 70%.

Conclusion

Even if major accident mechanics were included in the admission triage criteria, overtriage was limited to 30%. On the other hand, undertriage was approximate to zero, and the only two yellow codes missed were related to miscommunication by the prehospital team.