Retrospective Study
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World J Crit Care Med. Aug 4, 2014; 3(3): 68-73
Published online Aug 4, 2014. doi: 10.5492/wjccm.v3.i3.68
French pre-hospital trauma triage criteria: Does the “pre-hospital resuscitation” criterion provide additional benefit in triage?
Emmanuel Hornez, Olga Maurin, Aurélie Mayet, Tristan Monchal, Federico Gonzalez, Delphine Kerebel
Emmanuel Hornez, Digestive Surgery, Percy Military Hospital, 92140 Clamart, France
Emmanuel Hornez, Service de Chirurgie Thoracique et Viscérale, Hôpital d’Instruction des Armées PERCY, 92140 Clamart, France
Olga Maurin, Medical Service, Fire Department, 75012 Paris, France
Aurélie Mayet, Department of Epidemiology, Health Service, French Armed Forces, 13000 Marseille, France
Tristan Monchal, Digestive Surgery, Sainte Anne Military Hospital, 83000 Toulon, France
Federico Gonzalez, Digestive Surgery, Percy Military Hospital, French Armed Forces, 92140 Clamart, France
Delphine Kerebel, Emergency Department, Sainte Anne Military Hospital, 83000 Toulon, France
Author contributions: Hornez E contributed to the study conception and design; Maurin O and Kerebel D contributed to the acquisition of data; Hornez E, Mayet A and Monchal T contributed to the analysis and interpretation of data; Hornez E and Gonzalez F contributed to the drafting of manuscript; Gonzalez F contributed to critical revision.
Correspondence to: Emmanuel Hornez, MD, Service de Chirurgie Thoracique et Viscérale, Hôpital d’Instruction des Armées PERCY, 101 Avenue Henri Barbusse, 92140 Clamart, France. emmanuelhornez@free.fr
Telephone: +33-14-1466167 Fax: +33-14-1466169
Received: April 7, 2014
Revised: June 21, 2014
Accepted: July 25, 2014
Published online: August 4, 2014
Processing time: 164 Days and 22.5 Hours
Abstract

AIM: To evaluate the performance of the specific French Vittel “Pre-Hospital (PH) resuscitation” criteria in selecting polytrauma patients during the pre-hospital stage and its potential to increase the positive predictive value (PPV) of pre-hospital trauma triage.

METHODS: This was a monocentric prospective cohort study of injured adults transported by emergency medical service to a trauma center. Patients who met any of the field trauma triage criteria were considered “triage positive”. Hospital data was statistically linked to pre-hospital records. The primary outcome of defining a “major trauma patient” was Injury Severity Score (ISS) > 16.

RESULTS: There were a total of 200 injured patients evaluated over a 2 years period who met at least 1 triage criterion. The number of false positives was 64 patients (ISS < 16). The PPV was 68%. The sensitivity and the negative predictive value could not be evaluated in this study since it only included patients with positive Vittel criteria. The criterion of “PH resuscitation” was present for 64 patients (32%), but 10 of them had an ISS < 16. This was statistically significant in correlation with the severity of the trauma in univariate analysis (OR = 7.2; P = 0.005; 95%CI: 1.6-31.6). However, despite this correlation the overall PPV was not significantly increased by the use of the criterion “PH resuscitation” (68% vs 67.8%).

CONCLUSION: The criterion of “pre-hospital resuscitation” was statistically significant with the severity of the trauma, but did not increase the PPV. The use of “pre-hospital resuscitation” criterion could be re-considered if these results are confirmed by larger studies.

Keywords: Pre-hospital; Triage; Vittel criteria; Injury Severity Score; Trauma

Core tip: This is the first evaluation of French Vittel criteria for pre hospital triage of trauma. The results of this study suggest that the criteria are efficient to select the severe trauma patients during the pre-hospital stage [positive predictive value (PPV) of 68%]. The criterion “pre-hospital resuscitation” was significantly correlated with the severity of the trauma, but did not increase the PPV. This criterion, which is the only difference between French and United Stated pH triage criteria, does not procure extra value and compromises potential comparisons with multinational cohort studies. The use of “pre-hospital resuscitation” criterion should be revaluated if these results are confirmed by larger studies.