Field triage of victims of trauma. Efficacy of trauma team activation protocols

Background: Early recognition of major trauma enables health-care providers to accurately triage and transport injured patients to an appropriate hospital. Triage remains a core component in modern trauma systems as inaccurate assessment of injury severity has negative effects on quality of care, patient safety, and resource utilization. To optimize patient outcome, immediate resuscitation is increasingly being delivered via multidisciplinary trauma teams. However, several studies indicate a trend for imprecise activation of such teams. The overall goal of this thesis has been to improve trauma system efficacy through higher precision of field trauma triage. Methods: We conducted trauma registry studies on triage efficacy at two trauma centers. Further, we prospectively investigated if the efficacy can be improved by implementing a two-tiered trauma team activation protocol. We also sought to systematically review and investigate the quality of existing models that estimate the prognosis of patients in the early stages of care. Lastly, we explored the possible influence of different definitions of major trauma on triage precision calculations. Results: Our findings confirm that field triage remains a challenge to health-care providers but that a two-tiered triage system increased efficacy. To further increase triage precision, health-care providers need access to field-friendly models that estimate patient prognosis and guide their early evaluations. Although several prognostic models exist, there are many areas for methodological improvement. To compare datasets and conduct multicenter trials, a universally accepted definition of major trauma may be necessary. Conclusion: This thesis indicates that trauma system efficacy may be improved through higher precision of field triage of victims of trauma.