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

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.