• Frank J Voskens, Eveline A J van Rein, Rogier van der Sluijs, Roderick M Houwert, Robert Anton Lichtveld, Egbert J Verleisdonk, Michiel Segers, Ger van Olden, Marcel Dijkgraaf, Leenen Luke P H LPH Department of Surgery, University Medical Center Utrecht, Utrecht, the Netherlands., and Mark van Heijl.
• Department of Surgery, University Medical Center Utrecht, Utrecht, the Netherlands.
• JAMA Surg. 2018 Apr 1; 153 (4): 322-327.

ImportanceA major component of trauma care is adequate prehospital triage. To optimize the prehospital triage system, it is essential to gain insight in the quality of prehospital triage of the entire trauma system.ObjectiveTo prospectively evaluate the quality of the field triage system to identify severely injured adult trauma patients.Design, Setting, And ParticipantsPrehospital and hospital data of all adult trauma patients during 2012 to 2014 transported with the highest priority by emergency medical services professionals to 10 hospitals in Central Netherlands were prospectively collected. Prehospital data collected by the emergency medical services professionals were matched to hospital data collected in the trauma registry. An Injury Severity Score of 16 or more was used to determine severe injury.Main Outcomes And MeasuresThe quality and diagnostic accuracy of the field triage protocol and compliance of emergency medical services professionals to the protocol.ResultsA total of 4950 trauma patients were evaluated of which 436 (8.8%) patients were severely injured. The undertriage rate based on actual destination facility was 21.6% (95% CI, 18.0-25.7) with an overtriage rate of 30.6% (95% CI, 29.3-32.0). Analysis of the protocol itself, regardless of destination facility, resulted in an undertriage of 63.8% (95% CI, 59.2-68.1) and overtriage of 7.4% (95% CI, 6.7-8.2). The compliance to the field triage trauma protocol was 73% for patients with a level 1 indication.Conclusions And RelevanceMore than 20% of the patients with severe injuries were not transported to a level I trauma center. These patients are at risk for preventable morbidity and mortality. This finding indicates the need for improvement of the prehospital triage protocol.

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