Adherence with the pre-hospital triage protocol in the transport of injured patients in an urban setting

Abstract

Background: Pre-hospital triage protocols are an important component in the treatment of injured patients. The aim was to determine the level of, and factors associated with, adherence to the pre-hospital trauma triage criteria for urban patients transported in New South Wales, Australia.

Method: This retrospective study included patients injured in urban areas who were transported by road for the treatment of traumatic injuries in the period 1 July 2006 to 30 June 2007.

Results: Of the 57,775 transported to hospital due to traumatic injury, 9344 (16%) met one or more of the pre-hospital triage criteria. Of these, 74% were transported to a protocol adherent major or regional trauma centre. Adherence rates differed by triage criteria met and was lowest for patients meeting physiologic-only criteria (63.5%) and highest for patients meeting all three triage criteria of physiology, mechanism and injury (85.4%). Female gender, increasing patient age, patients classified as having had a fall, the qualification level of treating officer and patients transported between midday to 18:00 (relative to those transported between midnight to 06:00) were factors associated with significantly lower levels of protocol adherence with respect to hospital destination. Minimal time differences were evident between patients transported to protocol adherent and non-adherent destinations.

Conclusion: Based on the post hoc evaluation of triage status, adherence to the triage protocol was 74%. Analysis of patient destinations for protocol non-adherence appears to indicate that paramedic interpretation and discretion played a role in determining hospital choice. There was a marginal time difference between those transported to protocol adherent and non-adherent destinations. Future research needs to determine whether deviations from protocol are associated with differential mortality.