Paramedic injury severity perception can aid trauma triage

Area of Science:

• Emergency Medicine
• Trauma Surgery
• Public Health

Background:

• Standard out-of-hospital trauma triage relies on objective criteria.
• Accurate patient assessment in prehospital settings is crucial for timely trauma center evaluation.
• Advanced Emergency Medical Technicians (EMTs) possess unique insights into injury severity.

Purpose of the Study:

• To compare the effectiveness of standard trauma triage criteria versus standard criteria augmented by advanced EMT injury severity perception.
• To determine if advanced EMTs' subjective assessment improves the identification of patients requiring trauma center evaluation.

Main Methods:

• Prospective, observational cohort analysis of trauma triage by advanced EMTs in Oregon.
• Data collected included demographics, physiology, injury details, and EMTs' perceived injury severity.
• Need for trauma center evaluation was defined by specific clinical outcomes and Injury Severity Score.

Main Results:

• Advanced EMTs' injury severity perception significantly improved the accuracy of trauma triage, as indicated by receiver operating characteristic (ROC) curve analysis (0.88 vs 0.83).
• Logistic regression models showed that subjective injury severity perception provided substantial predictive value, with odds ratios of 20:1 and 167:1 for the highest perception categories.
• Standard criteria like low systolic blood pressure, abnormal respiratory rate, low Glasgow Coma Scale score, and specific injury types remained significant predictors when combined with EMT perception.

Conclusions:

• The inclusion of advanced EMTs' injury severity perception information enhances standard out-of-hospital trauma triage criteria.
• This subjective assessment provides valuable data for more accurate prehospital trauma patient evaluation.
• Integrating advanced EMTs' clinical judgment can optimize patient allocation to appropriate trauma care facilities.