Risk factors and mortality associated with undertriage after major trauma in a physician- led prehospital system: a retrospective multicentre cohort study

Abstract Background Direct transport of patients suffering major trauma to level-I trauma centres may reduce mortality. Emergency medical services therefore aim to limit undertriage so that all severely injured patients receive proper vital trauma care. Nevertheless, undertriage have been poorly examined in a physician-led prehospital system. The main objective of this study was to assess the incidence of undertriage. We also sought to determine its potential risk factors, as well as to assess its association with mortality. Methods A multicentre retrospective cohort study was performed using 2011–2017 data from a French regional trauma registry (RESUVal) that includes prehospital, and in-hospital data on trauma patients. All adults assessed by a physician-led mobile medical team with major trauma (Injury Severity Score [ISS] ≥ 16) were included. Major trauma patients transported directly to a level-I trauma centre were considered as correctly triaged. Multivariate logistic regression was used to identify factors associated with undertriage. Results 7,110 trauma patients were screened, of whom 2,591 had an ISS ≥ 16. Median age was 42 (IQR 27–59) years old, 75.0% were male and 12.4% (n = 320) were undertriaged. In-hospital mortality was 18.3% among undertriaged patients vs 16.2% among correct-triaged patients (p = 0.473). Patients aged 51–65 years had higher risk for undertriage (OR = 1.60, 95%CI [1.11;2.26], p = 0.01). Conversely, mechanism (fall from height 0.62 [0.45;0.86], p = 0.01; gunshot/stab wounds 0.45 [0.22;0.90], p = 0.02), longer on-scene time (> 60 minutes, 0.62 [0.40;0.95], p = 0.03), prehospital endotracheal intubation (0.53 [0.39;0.71], p < 0.001), and prehospital focused assessment with sonography FAST (0.15 [0.08;0.29], p < 0.001) were associated with a lower risk for undertriage. After adjusting on severity, undertriage was not significantly associated with a greater risk of mortality (1.22 [0.80;1.89], p = 0.36). Conclusions In our region-wide, physician-led prehospital EMS system, undertriage in major trauma was higher than recommended and advanced age was associated with higher risk for undertriage. Conversely, a pre-hospital FAST was associated with a lower risk for undertriage. Specific triage procedures should be discussed in older trauma patients and further studies are needed to evaluate the impact of prehospital FAST on triage performance. We noted that undertriaged patients had no higher risk for mortality suggesting no impact of secondarily transfer and/or high trauma care quality in level-II trauma centres. Undertriage definition should be tailored to fit local trauma systems organization.

Récupéré en direct depuis OpenAlex et désinversé. Les résumés ne sont pas conservés dans cette base de données : les index inversés représentent 8,6 Go des 9,3 Go de texte de la base, et le serveur dispose de 13 Go libres.