Accuracy of pre-hospital triage protocols in selecting severely injured patients: A systematic review

van Rein EAJ, Houwert RM, Gunning AC, Lichtveld RA, Leenen LPH, van Heijl M. Journal of Trauma and Acute Care Surgery. 2017;83(2):328-39.

Pre-hospital trauma triage ensures proper transport of patients at risk of severe injury to hospitals with an appropriate corresponding level of trauma care. Incorrect triage results in undertriage and overtriage. The American College of Surgeons Committee on Trauma recommends an undertriage rate below 5% and an overtriage rate below 50% for pre-hospital trauma triage protocols. To find the most accurate pre-hospital trauma triage protocol, a clear overview of all currently available protocols and corresponding outcomes is necessary.

The aim of this systematic review was to evaluate the current literature on all available pre-hospital trauma triage protocols and determine accuracy of protocol-based triage quality in terms of sensitivity and specificity.

This systematic review shows that nearly all protocols are incapable of identifying severely injured patients. Future studies of high methodological quality should be performed to improve pre-hospital trauma triage protocols.