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IDENTIFYING TRAUMA CENTRE NEED (TCN) IN ADULTS SUSTAINING INJURY: A NARRATIVE REVIEW
  1. A Follows1,2,
  2. R Phillips1,2,
  3. J Vassallo1,3
  1. 1 Emergency Department, Plymouth Hospital, Plymouth, UK
  2. 2 Peninsula College of Medicine and Dentistry, Plymouth, UK
  3. 3 Institute of Naval Medicine, Gosport, UK

Abstract

Objectives & Background Field triage is the process of identifying patients who, sustaining trauma, are in need of treatment at a trauma centre (TCN – trauma centre need). This is acheived by Emergency Medical Service (EMS) personnel employing a field-triage algorithm to enable them to make this decision; within the UK there is considerable variation between algorithms, dependent on the region. In common, is a four tier approach looking at a patient's physiological derangement, their likely anatomical injury, mechanism of injury and other special considerations in turn to determine whether TCN is indicated. Optimum triage is desired as both under and over triage have been proven to have a negative impact on patient morbidity and mortality. Guidelines within the USA suggest that the performance of field triage algorithms be sufficient to limit under and over triage to <10% and <50% respectively. The objective of this study was to review the literature to determine the evidence base and the ability of mechanism of injury, anatomical injury and/or physiological derangement at predicting TCN in the adult patient sustaining injury.

Methods Using NHS Evidence a literature search of MEDLINE (1946) and EMBASE (1974) was conducted to week 3 May 2016. Only articles published in English were included.

Results The search produced 241 articles, following a review of title and abstract 26 written English papers were identified to review in full. 5 papers were removed as inaccessible as full-text. Following full text review 9 were removed as non relevant. The remaining 12 relevant papers were included in the review.

Conclusion There is a paucity of high quality evidence (RCTs) surrounding pre-hospital triage of traumatically injury adult patients, with a number of studies contradicting one-another. The majority of the literature is reliant on the retrospective analysis of trauma registries with their associated limitations such as incomplete data capture and selection bias. There is currently no consensus as to what constitutes TCN, with both the output measured differing between identified studies and also the statistics employed to assess performance.

Although there is some evidence to support physiological, anatomical injury and mechanism of injury as a predictor of TCN, it is not of high quality & is contradictory. Targeted research is required to determine the optimum method of pre-hospital identification of the adult trauma patient.

  • Trauma

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