Paramedic Judgment as a Basis for Trauma Triage: Is it an Effective Strategy?

Abstract

Introduction

American College of Surgeons-Committee on Trauma (ACS-COT) defines minimum Standard Criteria (SC) for Level 1 trauma. In our hospital, discretion of prehospital personnel (“Paramedic Judgment” [PJ]) can initiate Full Trauma Triage Activation (FTTA) in the absence of ACS-COT criteria. The aim of this study was to evaluate overtriage and undertriage for PJ vs SC.

Methods

1846 patients met criteria from 1/1/19 to 1/5/23. This study utilized the Cribari Matrix to define under, over, and appropriate triage, and utilizes Chi-Squared Test to determine significance. We performed an adjusted binomial logistic regression comparing overtriage and undertriage for PJ vs SC. We analyzed the Need for Emergent Intervention-6 (NEI-6) model to see if it could be a way to accurately assess triage.

Results

Overtriage for the PJ group was 68.9%, compared to 54.8% for SC, with a P-value ≤.05, and undertriage for the PJ group was 1.23% compared to 0.13%. After adjusting for confounders, the risk of overtriage by the PJ group was 2.04 times as likely compared to the SC group (OR 2.04; P < .01). The OR for undertriage was not calculated due to lack of power. The odds of needing a blood transfusion for the PJ patients compared to the SC patients is approximately one-third (OR 0.33; P < .01). The other variables were lacking in power.

Conclusion

The aim of this study is to evaluate over and undertriage for PJ and SC at our large urban center. We found that overtriage was 2 times as likely when using PJ compared with the SC.