Accuracy of trauma triage in patients transported by helicopter.

Background: Our objective was to study the accuracy of the American College of Surgeons Trauma Triage Scheme in trauma patients transported by helicopter from the scene of injury.

Methods: This is a case series of 333 patients transported by helicopter from the scene of injury to a University Hospital Level 1 Trauma Center. We constructed 2 x 2 tables with the use of injury Severity Score > 15 as the "gold standard" for major trauma and assessed the Trauma Triage Scheme (overall) and its physiologic, situational, and age/comorbidity components individually.

Results: Physiologic criteria had high specificity (85.7%) but low sensitivity (55.6%), whereas situational criteria had high sensitivity (86.6%) but low specificity (19.9%). Use of physiologic criteria alone would miss 67 of 151 patients with injury Severity Score > 15 and five of 31 fatalities. Situational criteria capture 58 of the 67 major trauma patients missed by the physiologic criteria but also 125 minor trauma patients. Age/comorbidity criteria had low positive (22.7%) and negative (10%) predictive values.

Conclusions: Physiologic triage criteria alone identify only half of trauma patients with injury Severity Score > 15. Situational criteria are needed to identify most patients with injury Severity Score > 15, but this also captures many patients with minor injury. If the Trauma Triage Scheme situational criteria could be improved, trauma overtriage might be reduced with resultant health care cost savings.