Under-Triage and Over-Triage Using the Field Triage Guidelines for Injured Patients: A Systematic Review

Area of Science:

• Emergency Medicine
• Trauma Surgery
• Public Health

Background:

• The Field Triage Guidelines (FTG) are critical for directing severely injured patients to appropriate trauma centers in North America.
• Current FTG goals aim for under-triage below 5% and over-triage between 25% and 35%.

Approach:

• A systematic literature review was conducted using Ovid Medline, EMBASE, and Cochrane databases (January 2011 - February 2021).
• Studies evaluating prehospital FTG under- and over-triage rates were included, with risk of bias assessed.
• Under-triage (seriously injured patients to non-trauma centers) and over-triage (non-injured patients to trauma centers) were the primary accuracy measures.

Key Points:

• Seventeen studies evaluating FTG accuracy were identified.
• Under-triage rates in studies using the full FTG ranged from 1.6% to 72.0%, with higher rates in pediatric and older adult populations.
• Over-triage rates varied from 9.9% to 87.4%, generally higher in all-age groups compared to older adults and pediatric patients.
• Strict retrospective application of FTG reduced under-triage but increased over-triage compared to as-practiced application.

Conclusions:

• The FTG, despite potential improvement with strict application, demonstrates under-triage rates exceeding targets, particularly for vulnerable pediatric and geriatric populations.
• Over-triage rates also present challenges, suggesting the FTG may not optimally balance sensitivity and specificity across diverse patient demographics.
• Further refinement of the FTG is warranted to improve accuracy and ensure appropriate trauma center utilization for all seriously injured patients.