External validation of the Dutch prediction model for prehospital triage of trauma patients in South West region of England, United Kingdom. Issue 5 (May 2021)

• Record Type: Journal Article
• Authors: Shanahan, Thomas A G; Fuller, Gordon Ward; Sheldon, Trevor; Turton, Emily; Quilty, Fionn Michael Appleton; Marincowitz, Carl
• Is Part Of: Injury. Volume 52:Issue 5(2021)
• Page Start: 1108
• Page End: 1116
• Publication Date: 2021-05
• Subjects: Wounds and injuries -- Surgery -- Periodicals; Accidents -- Periodicals; Wounds and Injuries -- surgery -- Periodicals; Lésions et blessures -- Chirurgie -- Périodiques; Electronic journals; Electronic journals; 617.1
• DOI: 10.1016/j.injury.2021.01.039
• Languages: English
• ISSNs: 0020-1383

Abstract

Highlights: First study to externally validate the only empirically derived European prediction model for identifying majortrauma in undifferentiated pre-hospital patients. Implementing the Dutch model could lower the undertriage rate from 56% to 17%, however it would increase the overtriage rate from 16% to 50%. Further research is needed to reduce overtriage and determine whether the model can be practically implemented by paramedics and is cost-effective. Abstract: Importance: This paper investigates the use of a major trauma prediction model in the UK setting. We demonstrate that application of this model could reduce the number of patients with major trauma being incorrectly sent to non-specialist hospitals. However, more research is needed to reduce over-triage and unnecessary transfer to Major Trauma Centres. Objective: To externally validate the Dutch prediction model for identifying major trauma in a large unselected prehospital population of injured patients in England. Design: External validation using a retrospective cohort of injured patients who ambulance crews transported to hospitals. Setting: South West region of England. Participants: All patients ≥ 16 years with a suspected injury and transported by ambulance in the year from February 1, 2017. Exclusion criteria: 1) Patients aged ≤15 years; 2) Non-ambulance attendance at hospital with injuries; 3) Death at the scene and; 4) Patients conveyed by helicopter. This study had a census sample of cases available to us over a one year period. Interventions or exposures: Tested the accuracy of the prediction model in terms of discrimination, calibration, clinical usefulness, sensitivity and specificity and under- and over triage rates compared to usual triage practices in the South West region. Main outcome measure: Major trauma defined as an Injury Severity Score>15. Results: A total of 68799 adult patients were included in the external validation cohort. The median age of patients was 72 (i.q.r. 46-84); 55.5% were female; and 524 (0.8%) had an Injury Severity Score>15. The model achieved good discrimination with a C-Statistic 0.75 (95% CI, 0.73 – 0.78). The maximal specificity of 50% and sensitivity of 83% suggests the model could improve undertriage rates at the expense of increased overtriage rates compared with routine trauma triage methods used in the South West, England. Conclusions and relevance: The Dutch prediction model for identifying major trauma could lower the undertriage rate to 17%, however it would increase the overtriage rate to 50% in this United Kingdom cohort. Further prospective research is needed to determine whether the model can be practically implemented by paramedics and is cost-effective.