Risk factors and mortality associated with undertriage after major trauma in a physician-led prehospital system: a retrospective multicentre cohort study - Archive ouverte HAL Access content directly
Journal Articles European Journal of Trauma and Emergency Surgery Year : 2022

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

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1
Axel Benhamed
Laurie Fraticelli
Clément Claustre
  • Function : Author
Amaury Gossiome
  • Function : Author
Eric Cesareo
  • Function : Author
Matthieu Heidet
  • Function : Author
Marcel Emond
  • Function : Author
Eric Mercier
  • Function : Author
Valérie Boucher
  • Function : Author
Jean-Stéphane David
  • Function : Author
Carlos El Khoury
  • Function : Author
Karim Tazarourte
  • Function : Author

Abstract

Purpose: To assess the incidence of undertriage in major trauma, its determinant, and association with mortality. Methods: A multicentre retrospective cohort study was conducted using data from a French regional trauma registry (2011-2017). All major trauma (Injury Severity Score ≥ 16) cases aged ≥ 18 years and managed by a physician-led mobile medical team were included. Those transported to a level-II/III trauma centre were considered as undertriaged. Multivariable logistic regression was used to identify factors associated with undertriage. Results: A total of 7110 trauma patients were screened; 2591 had an ISS ≥ 16 and 320 (12.4%) of these were undertriaged. Older patients had higher risk for undertriage (51-65 years: OR = 1.60, 95% CI [1.11; 2.26], p = 0.01). Conversely, injury mechanism (fall from height: 0.62 [0.45; 0.86], p = 0.01; gunshot/stab injuries: 0.45 [0.22; 0.90], p = 0.02), on-scene time (> 60 min: 0.62 [0.40; 0.95], p = 0.03), prehospital endotracheal intubation (0.53 [0.39; 0.71], p < 0.001), and prehospital focussed assessment with sonography [FAST] (0.15 [0.08; 0.29], p < 0.001) were associated with a lower risk for undertriage. After adjusting for severity, undertriage was not associated with a higher risk of mortality (1.22 [0.80; 1.89], p = 0.36). Conclusions: In our physician-led prehospital EMS system, undertriage was higher than recommended. Advanced aged was identified as a risk factor highlighting the urgent need for tailored triage protocol in this population. Conversely, the potential benefit of prehospital FAST on triage performance should be furthered explored as it may reduce undertriage. Fall from height and penetrating trauma were associated with a lower risk for undertriage suggesting that healthcare providers should remain vigilant of the potential seriousness of trauma associated with low-energy mechanisms.

Dates and versions

hal-03895751 , version 1 (13-12-2022)

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Axel Benhamed, Laurie Fraticelli, Clément Claustre, Amaury Gossiome, Eric Cesareo, et al.. Risk factors and mortality associated with undertriage after major trauma in a physician-led prehospital system: a retrospective multicentre cohort study. European Journal of Trauma and Emergency Surgery, 2022, ⟨10.1007/s00068-022-02186-5⟩. ⟨hal-03895751⟩

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