Performance of updated American College of Surgeons field triage guidelines in identifying need for trauma center care.

OBJECTIVE

The Guidelines for the Field Triage of injured patients were updated in 2021 to improve the reliability of prehospital trauma triage. The objective of this study was to describe the association of the 2021 Field Triage Guidelines criteria with need for advanced trauma center care from a cohort of patients transported to a level 1 trauma center.

METHODS

This was a health records review of Field Triage Guidelines criteria met for trauma team activations at a level 1 trauma center from January 2020 to December 2021. Hospital-based and injury severity score (ISS)-based trauma center need were defined and sensitivity and specificity of the Field Triage Guidelines calculated for both. Area under the receiver operator curves were used to assess accuracy. Multivariable logistic regression was used to evaluate the association of each criterion with trauma center need.

RESULTS

A total of 1427 patients were included and 90.3% met at least one Field Triage Guidelines criteria. Overall, patients meeting hospital-based trauma center need was 33.8% compared to 28.4% which met ISS-based trauma center need. Field Triage Guidelines criteria demonstrated a sensitivity of 97.3% and specificity of 13.3% with respect to hospital-based trauma center need with an area under the ROC of 0.80. Mental status and vital signs showed the highest association with trauma center need.

CONCLUSION

The updated 2021 Field Triage Guidelines demonstrate good accuracy when assessed retrospectively on a cohort of patients transferred to a level 1 trauma center. The very high sensitivity of the new guidelines may help to reduce undertriage rates to the international goal of <5%. New criteria in this iteration of the Field Triage Guidelines could lead to improved rates of undertriage specifically in severely injured geriatric patients.