French pre-hospital trauma triage criteria: Does the “pre-hospital resuscitation” criterion provide additional benefit in triage?

Table 1 Vittel pre-hospital triage criteria¹

Steps	Severity criteria
1 Vital signs	Glasgow coma scale < 13 or
	Systolic blood pressure < 90 mmHg or
	Saturation O2 < 90%
2 Evidence of high-energy trauma	Ejection from automobile
	Death in same passenger compartment
	Falls > 6 m
	Victim thrown or crushed
	Global assessment of the trauma (aspect of the crashed vehicle, vehicle telemetry data consistent with high risk of injury, no motorcycle helmet, no seat belt)
	Blast
3 Anatomy of injury	Penetrating trauma of head, neck thorax, abdomen, pelvis, thigh, and arm
	Flail chest
	Severe burns, smoke inhalation
	Pelvic bone fracture
	Suspicion of medullar trauma
	Amputation proximal to wrist or ankle
	Acute ischemia of the limb
4 Pre-hospital resuscitation	Intubated and mechanically ventilated patients
	IV Fluids > 1000 mL (colloids)
	Catecholamine
	Anti-shock trousers inflated
5 Special patient or system considerations	Age > 65 yr
	Heart failure
	Respiratory failure
	Pregnancy > 12 wk

¹The patient is considered as a severe trauma if he met one of the listed criteria and transferred to a trauma center.

Table 2 Profile of injury

Mechanism	n (%)
Motorcycle crash	105 (52.7)
Car crash	37 (18.5)
Fall	30 (15.8)
Pedestrian vs auto	16 (8)
Gunshot wound	5 (2.5)
Stab wound	2 (1)
Other	4 (2)
Anatomy of injury
	Total n (%)	Hemorragic group n (%)
Number	200	33 (16.5)
Extremity
Upper	60 (30)	8 (24)
Lower	53 (26.5)	9 (28)
Thorax
Lung trauma	39 (19.5)	3 (9)
Pneumothorax	29 (14.5)	4 (12)
Hemothorax	21 (10.5)	14 (42.5)
Head	97 (48.5)	14 (42.5)
Face	39 (19.5)	4 (12)
Spine
Stable	29 (14.5)	4 (12)
Unstable	8 (4)	0
Pelvic bone
Stable	26 (13)	4 (12)
Unstable	10 (5)	6 (18)
Abdomen
Hemoperitoneum	31 (15.5)	17 (51.5)
Hemoretroperitoneum	13 (6.5)	6 (18)
Pneumoperitoneum	3 (1.5)	1 (3)
Other	3 (1.5)	1 (3)

Table 3 Correlation between the severity of trauma¹ and positive Vittel criteria

Vittel Criteria	Univariate analysis			Multivariate analysis
	OR	P	95%CI	OR	P	95%CI
Vital signs	2.8	0.002	1.4-5.3	2.4	0.04	1.0-5.7
Evidence of high-energy trauma	1	0.8	0.5- 2.4	1.2	0.64	0.5-3.1
Anatomy of injury	0.6	0.2	0.2-1.4	0.5	0.21	0.2-1.5
Pre-hospital resuscitation	2.6	0.005	1.3-5.0	1.8	0.18	0.7-4.4
Special patient or system considerations	7.2	0.009	1.6-31.6	9.2	0.004	2.0-41.9

¹ISS > 16.