Published in:
01-02-2014 | Original Article
Refining the trauma triage algorithm at an Australian major trauma centre: derivation and internal validation of a triage risk score
Published in: European Journal of Trauma and Emergency Surgery | Issue 1/2014
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Purpose
To derive and internally validate a clinical prediction rule for trauma triage.
Methods
Ambulance presentations requiring trauma team activation between 2007 and 2011 at a single inner city major trauma centre were analysed. The primary outcome was major trauma, defined as Injury Severity Score >15, intensive care unit admission or in-hospital death. Demographic details, vital signs on arrival at hospital, mechanism of injury and injured body regions were used in the modelling process. Multivariable logistic regression was used on a randomly selected derivation sample. Receiver operating characteristic (ROC) analysis and Hosmer–Lemeshow tests were used to assess the discrimination and calibration of the derived model. The model was further tested using bootstrapping cross-validation.
Results
A total of 3027 patients were identified. Predictors selected for the prediction model were age ≥65 years (OR 1.58, 95 %CI 1.08–2.32, p = 0.02), abnormal vital signs (OR 3.72, 95 %CI 2.64–5.25), Glasgow Coma Scale score ≤13 (OR 14, 95 %CI 9.23–23.34 p < 0.001), penetrating injury (OR 5.13, 95 %CI 2.76–9.54, p < 0.001), multiregion injury (OR 4.72 95 %CI 3.45–6.46, p < 0.001), falls (OR 1.51 95 %CI 1.06–2.15, p = 0.02) and motor vehicle crashes (OR 0.56, 95 %CI 0.35–0.90, p = 0.02). The ROC area under the curve (AUC) for the final model was 0.85 (95 %CI 0.83–0.87) with a Hosmer–Lemeshow test statistic p = 0.83. Bootstrapping cross-validation demonstrated an identical AUC.
Conclusion
We have derived and internally validated a trauma risk prediction rule using trauma registry data. This may assist with the formulation of revised local and regional trauma triage protocols. External validation is required before implementation.