The Association of Prehospital Care Level and Triage Accuracy with Trauma Outcomes: A Multi-Country, Multicenter Cohort Study.

Background: Proper triage and transport to trauma centers improve outcomes for severe trauma patients. However, little is known regarding these processes across Latin American healthcare systems, limiting regional improvement efforts.

Objective: This study aims to evaluate the association of prehospital care level and triage accuracy with hospital outcomes in trauma patients in Latin America.

Methods: This prospective cohort study was conducted in 14 hospitals across Argentina, Brazil, and Colombia. Inclusion criteria were adult trauma patients aged ≥18 years admitted directly from the scene of injury. Data collection occurred over 30 consecutive days at each hospital between 2019 and 2021. Predictor variables included the level of prehospital care (none, basic, or intermediate/advanced) and triage accuracy (correct, undertriage, or overtriage). The primary outcomes were hospital length of stay and mortality. Associations were analyzed using linear regression for hospital stay and logistic regression for mortality.

Results: A total of 1,193 trauma patients were included (62.4% male, mean age 43.5 years. Motor vehicle crashes (43.3%) and falls (36.1%) were the leading causes of injury. Emergency medical services assisted 58.7% of patients, mainly at a basic level ( n = 530). Overtriage occurred in 50.0%. Intermediate/advanced prehospital care was associated with longer hospital stays (β3.64, 95% CI [1.39, 5.89], p = .002). Neither prehospital care level nor triage accuracy was associated with hospital mortality ( p ≥.050).

Conclusions: In our study of 14 hospitals across Argentina, Brazil, and Colombia, intermediate/advanced prehospital care was associated with longer hospital stays. Neither prehospital care level nor triage categorization was associated with hospital mortality.