Validation of the criteria for early critical care resource use in assessing the effectiveness of field triage

Abstract

Background: This study aimed to validate the criteria for early critical care resource (CCR) use as an outcome predictor for seriously injured patients triaged in the field by comparing the effectiveness of the criteria for early CCR use with that of criteria defined by an Injury Severity Score (ISS) ˃15. Methods: We analysed data from seriously injured trauma patients who were triaged using a field triage protocol by emergency medical service providers (EMS-ST patients). Early CCR use was defined as the use of any of the following treatment modalities or outcomes: advanced airway management, blood transfusion, or interventional radiology (˂4 h), emergency operation or cardiopulmonary resuscitation, or thoracotomy (˂24 h), or admission for spinal cord injury. The primary endpoint was inhospital mortality. We generated area under the receiver operating characteristic (AUROC) curves to compare the value of the early CCR use criteria with that of the ISS N15 criteria in the discrimination between survivors and non-survivors. Results: Of the 14,352 adult EMS-ST patients, 9299 were enrolled in this study. Approximately 19.6% required early CCR use, and 18.0% had an ISS ˃ 15. The rate of in-hospital mortality was 9.4%. The AUROC values for the performances of the early CCR use and ISS ˃ 15 criteria in the prediction of in-hospital mortalitywere 0.89 (95% confidence interval [CI] 0.85-0.91) and 0.84 (95% CI 0.79-0.86), respectively (p ˂ 0.01). Conclusion: The early CCR use criteria demonstrated better performance than the ISS ˃ 15 criteria in the prediction of mortality in EMS-ST patients.