Efficacy of the Protocol for Trauma Team Activation in Taipei: A Retrospective Study.

Abstract

Introduction: Trauma triage is the use of trauma assessment for prioritizing patients for treatment or transport by injury severity. According to Taiwan Public Health Report, accidents and their adverse events were the sixth leading cause of death and accounted for over 7000 casualties in 2009. However, a lack of accuracy in identifying the severity of a patient's injury and their prehospital information can result in inappropriate triage. This study evaluated the efficacy of field triage guidelines governing trauma team activation in Taipei and explored the characteristics of undertriaged and overtriaged patients. Methods: This study retrospectively observed all patients with trauma transported to the emergency department of a medical center by Taipei City public ambulance from January 1, 2016, to December 31, 2019. A total of 2217 patients were included. The Cribari matrix method was used to assess undertriage and overtriage. A logistic regression was employed to analyze the effect of risk factors in patients with major trauma. Results: In this study, 320 and 1897 patients with trauma had full and limited trauma team activation, respectively. Among them, 664 patients with trauma were older than 65 years, and most of them were injured in a traffic accident. Among patients with major trauma, 24, 214, and 156 patients were aged < 20, 20-65, and > 65 years, respectively. A logistic regression analysis revealed that patients with a Glasgow Coma Scale score of less than 13, with systolic blood pressure level of less than 90, and with respiratory rate over 30 breaths per minute was more likely to be appropriately triaged. Conclusion: The Taipei prehospital field triage guidelines are acceptable but not an ideal tool for identifying patients with major trauma, with an overtriage rate of 48.12% and an undertriage rate of 12.03%. To decrease undertriage or overtriage rates, emergency medical service providers should receive comprehensive training.