Accuracy of trauma triage in patients transported by helicopter

Our objective was to study the accuracy of the American College of Surgeons Trauma Triage Scheme in trauma patients transported by helicopter from the scene of injury.

This is a case series of 333 patients transported by helicopter from the scene of injury to a University Hospital Level 1 Trauma Center. We constructed 2 x 2 tables with the use of injury Severity Score > 15 as the "gold standard" for major trauma and assessed the Trauma Triage Scheme (overall) and its physiologic, situational, and age/comorbidity components individually.

Physiologic criteria had high specificity (85.7%) but low sensitivity (55.6%), whereas situational criteria had high sensitivity (86.6%) but low specificity (19.9%). Use of physiologic criteria alone would miss 67 of 151 patients with injury Severity Score > 15 and five of 31 fatalities. Situational criteria capture 58 of the 67 major trauma patients missed by the physiologic criteria but also 125 minor trauma patients. Age/comorbidity criteria had low positive (22.7%) and negative (10%) predictive values.

Physiologic triage criteria alone identify only half of trauma patients with injury Severity Score > 15. Situational criteria are needed to identify most patients with injury Severity Score > 15, but this also captures many patients with minor injury. If the Trauma Triage Scheme situational criteria could be improved, trauma overtriage might be reduced with resultant health care cost savings.