Table 2 Performance characteristics of prehospital triage tools from a subset of the highest quality articles
From: Prehospital triage tools across the world: a scoping review of the published literature
Type | Study | Tool name | Pop | Primary research question | Major findings |
|---|---|---|---|---|---|
General | Meisel 2009 | PEAR | A | To validate PEAR for predicting hospital admission using routinely collected out-of-hospital information | AUC for combined cohort was 0.83 for all admissions and 0.72 for ICU admissions. n = 1102 |
Hoikka 2018 | NEWS | All | To examine the accuracy of the prehospitally implemented NEWS in predicting 1-day and 30-day mortalities in an unselected EMS population | The high-risk NEWS group (score ≥ 7) had sensitivities for 1-day and 30-day mortalities of 0.801 (CI 0.74–0.86) and 0.42 (CI 0.38–0.47), respectively. n = 12,426 | |
Leeies 2017 | CTAS | A | To prospectively evaluate CTAS interrater reliability between EMS providers and ED triage nurses | Interrater reliability κw = 0.437 (p < 0.001, 95% CI 0.421–0.452). n = 14,378 | |
Magnusson 2019 | RETTS-p | P | To evaluate agreement between the EMS field assessment using RETTS-p and the hospital diagnosis of emergent condition | Sn 66.7% and Sp 67.0%, with under-triage rate 33%, over-triage rate 33.3%. n = 716 | |
Stroke | Helwig 2019 | LAMS | A | To compare LAMS to Mobile Stroke Unit (MSU) in accurately triaging patients to the appropriate stroke hospital (CSC vs PSC) | An accurate triage decision was reached for 69.8% in the LAMS group and 100% in the MSU group (difference, 30.2%; 95% CI, 17.8%-42.5%; P < 0.001). n = 116 |
Carrera 2019 | RACE | A | To revalidate RACE after its region-wide implementation in Catalonia | RACE ≥ 5 showed Sn 84%, Sp 60%, AUC 0.77, for detecting LVO. N = 1822 | |
Jumaa 2019 | RACE | A | To report performance characteristics of RACE for LVO eligible for mechanical thrombectomy | A RACE cut-off point of ≥ 5 had Sn 77%, Sp 75%, PPV 0.97, NPV 0.25, accuracy 75.3% (95%CI 73.1–77.4). n = 1147 | |
Trauma triage | Brown 2011 | FTDS | A | To analyze whether trauma center need was accurately predicted solely by the physiologic (PHY) and anatomic (ANA) criteria of the FTDS | Application of only the PHY and ANA criteria identifies trauma center need with Sn 49%, Sp 78% and undertriage rate of 51%. Mechanism of injury and special considerations criteria play an important role in minimizing under-triage rates. n = 1,086,764 |
Newgard 2011 | FTDS | All | To evaluate diagnostic performance of FTDS for identifying major trauma (Injury Severity Score [ISS] ≥ 16) | Sn 85.8% (95% CI 85.0–86.6) and Sp 68.7% (95% CI 68.4–68.9). n = 122,345 | |
Barnett 2013 | FTDS | All | To describe the use of field triage criteria by EMS personnel in the Western United States | The three most common criteria cited (of 33 in use) were EMS provider judgment, age < 5 or > 55 years, and GCS < 14. n = 46,414 | |
Davidson 2014 | FTDS | All | To determine the likelihood of serious trauma based on vehicle damage sustained in a crash as described in Step 3 of the FTDS | Crash characteristics that predict severe injury included intrusion of greater than 12 inches (PPV of 10.4%; 95% CI, 9.5–11.3) and steering wheel collapse (PPV of 25.7%; 95% CI, 23.0–28.4%). n = 85,761 | |
Lerner 2017 | FTDS | P | To determine the change in under- and over-triage rates when the 2011 Field Triage Guidelines are compared to the 2006 and 1999 versions | Applying the 1999, 2006, or 2011 Guidelines to the EMS interview data the over-triage rate was 32.6%, 27.9%, and 28.0%, respectively. The under-triage rate was 26.5%, 35.1%, and 34.8%, respectively. The 2011 Guidelines resulted in an 8.2% (95% CI 0.6–15.9%) absolute increase in under-triage and a 4.6% (95% CI 2.8–6.3%) decrease in over-triage compared to 1999 Guidelines. n = 5594 | |
Ardolino 2015 | PTS | P | To assess performance of English pediatric prehospital trauma triage tools | East Midlands (18%), North West (21%) and Northern (19%) tools had the best over-triage rates. All had under-triage rates of 0%. n = 2934 | |
Cox 2012 | VSTTC | A | To evaluate performance of the Victorian prehospital trauma triage criteria in discriminating for major trauma | Sn 95.3%, Sp 62.7%, under-triage rate 4.7%, and over-triage rate 37.3% for major trauma. n = 45,332 | |
vanLaarhoven 2014 | Dutch | A | To evaluate the protocol's ability to identify severely injured adult trauma patients (ISS >  = 16) | Sn 89.1%, Sp 60.5%, PPV 26.5%, NPV 97.2%, undertriage rate 10.9%, overtriage rate 39.5%. n = 1607 | |
Trauma for helicopter EMS | Brown 2012 | FTDS | All | To determine which FTDS criteria can be used by field EMS providers to predict which trauma patients would benefit from helicopter transport | Odds of increased survival to discharge by helicopter transport found in following conditions: GCS < 14 (aOR 1.22); respiratory rate < 10 or > 29 (aOR 1.32); penetrating injury (aOR 1.40), age > 55 (aoR 1.15). n = 258,387 |
Brown 2017 | AMPT | A | To validate the effectiveness of the AMPT score to identify patients with a survival benefit from helicopter EMS (HEMS) | For AMPT score ≥ 2, HEMS increases odds of in-hospital survival by 6.7% (ARR 1.067; 95% CI 1.040–1.083, p < 0.001). n = 222,827 | |
Traumatic brain injury | Fuller 2016 | HITS-NS | A | To determine the accuracy of the HITS-NS triage rule for identifying patients with significant TBI | Sn 28.3% and Sp 94.4% for significant TBI. n = 3828 |