Developing a national triage tool for use in NHS regional trauma networks: the MATTS mixed methods study

Area of Science:

• Emergency medicine
• Trauma care
• Health services research

Background:

• Prehospital major trauma triage in the National Health Service (NHS) currently lacks standardization, with regional variations in tools and methods.
• This inconsistency impacts the accuracy and efficiency of patient care pathways.

Purpose of the Study:

• To develop and evaluate a national major trauma triage tool for prehospital use.
• The tool aims to be acceptable, usable, accurate, and optimize the balance between under-triage and over-triage.

Main Methods:

• A three-phase research program involving expert consensus, systematic reviews, document analysis, and decision-analytic modeling.
• Phase 2 included a case-cohort study to validate triage tools, identifying an optimal candidate.
• Phase 3 evaluated the implemented candidate tool through a cohort study assessing accuracy and cost-effectiveness.

Main Results:

• The developed Major Trauma Triage Study (MTSS) tool demonstrated optimal performance in Phase 2 (specificity 95.1%) and Phase 3 (specificity 94.3%).
• The MTSS tool achieved an acceptable under-/over-triage trade-off and was favorably received by stakeholders.
• While real-world cost-effectiveness showed minimal differences, theoretical analysis indicated the MTSS tool was cost-effective (ICER £21,163).

Conclusions:

• The MTSS triage tool is effective, balances under-/over-triage appropriately, and is well-received by users.
• National implementation offers the potential for standardized, evidence-based, and cost-effective prehospital trauma triage.