Impact of triage guidelines on prehospital triage: comparison of guidelines with a statistical model

The American College of Surgeons developed the National Field Triage Decision Scheme (NFTDS) that has been adapted by many trauma centers in the nation, but quantitative evidence of its efficacy is unclear. We compare the NFTDS and state of Ohio guidelines to the "observed" rates and with rates derived using a statistical model.

We used 4757 trauma records from 2008-2012 available from the state and calculated undertriage (UT) and overtriage (OT) rates. We then simulated the NFTDS and the state guidelines for those years and estimated the corresponding UT and OT rates. We finally compared these rates with those derived from a multivariate logistic regression model.

For the state data, both NFTDS and state guidelines produced lower UT rate (∼9%) compared with the observed rate (∼17%), whereas the OT rates were higher (>85%) than the observed rates (∼54%). The statistical model identified novel factors that were not directly available in the NFTDS; change in responsiveness (odds ratio [OR] = 1.924) and complaint in body (OR = 3.140), back (OR = 1.890), chest (OR = 3.191), head (OR = 3.878), and abdomen (OR = 2.966). Although the statistical model performed similar to observed rates, it performed considerably better than NFTDS (UT = 1.93% versus 9.03%; OT = 66.42% versus 87.52%) and state guidelines (UT = 2.18% versus 8.72%; OT = 64.09% versus 86.52%).

The current NFTDS and state's triage guidelines do not appear to achieve the ACS recommendation of <5% UT and <35% OT rates in the state of Ohio. Inclusion of region-specific factors may help enhance the current NFTDS guidelines and aid in the first impression or judgment of the Emergency Medical Services personnel to improve trauma care and reduce cost.