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Trauma is recognized as a serious health care problem world-wide and there is a general agreement that trauma is best addressed in a systematic manner. Accordingly, trauma systems must be designed to use efficiently the limited health care resources available. The majority of injuries are of only minor, or moderate, severity, and can be managed well at local community hospitals. On the other hand,...
To reduce overtriage of trauma patients while at the same time minimising undertriage, an in-hospital triage tool was developed with the purpose of reducing the initial full trauma team (downgrading) in a structured and evidence-based manner. This study evaluated the effect on overtriage rates by the AMC downgrading protocol (AMCDP) consisting of 24 criteria scored during the primary survey.We prospectively...
Scandinavian countries face common challenges in trauma care. It has been suggested that Scandinavian trauma system development is immature compared to that of other regions. We wanted to assess the current status of Scandinavian trauma management and system development.An extensive search of the Medline/Pubmed, EMBASE and SweMed+ databases was conducted. Wide coverage was prioritised over systematic...
To evaluate a two-tiered trauma activation protocol in a major trauma referral hospital in Australia.A prospective study performed over a 12-month period of all consecutive trauma activations in a major trauma referral hospital. The triage tool assigned patients into two tiers of trauma activation. The full trauma activation was initiated where physiological or anatomical criteria were present. These...
Globally, injury is amongst the leading causes of death and disability in all age groups. Despite the use of prehospital trauma triage guidelines, identification of older persons with severe, potentially life-threatening injuries has been problematic. The purpose of this paper is to review prehospital factors associated with severe injuries amongst older adults.MEDLINE, CINAHL, Embase, and Cochrane...
Appropriate triage of the trauma patient is essential to ensure prompt access to definitive care. Many trauma centres use a “tiered” trauma call protocol with the intention of providing a match between the facility's resources and the needs of the patient. This study describes the incidence and impact of undertriage on the trauma patient in the context of an Australian level 1 trauma centre with a...
There exists no standard hospital emergency department (ED) triage procedure model for earthquake victims. This study provides an overview of the hospital triage procedure used for patients evaluated and treated at the West China Hospital of Sichuan University, Chengdu in the Sichuan province of China, following the May 12, 2008 Wenchuan earthquake.Emergency triage and treatment teams were comprised...
The term “big bang” major incidents is used to describe sudden, usually traumatic, catastrophic events, involving relatively large numbers of injured individuals, where demands on clinical services rapidly outstrip the available resources. Triage tools support the pre-hospital provider to prioritise which patients to treat and/or transport first based upon clinical need. The aim of this review is...
There is a paucity of literature comparing trauma patients who meet pre-hospital trauma triage guidelines (‘potential major trauma’) with trauma patients who are identified as ‘confirmed major trauma patients’ at hospital discharge. This type of epidemiological surveillance is critical to continuous performance monitoring of mature trauma care systems. The current study aimed to determine if the current...
Efficient triage may have a major influence on mortality and morbidity as well as financial consequences. A continuous effort to improve this decision making process and update the trauma alert criteria is being made. However, criteria for determining the evacuation priority are not well developed. We performed a prospective study to evaluate which pre-hospital parameters identify major trauma victims...
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.This retrospective study included patients injured in urban areas who were transported by road for the treatment of traumatic...
A key challenge at a major incident is to quickly identify those casualties most urgently needing treatment in order to survive – triage. The UK Triage Sieve (TS) advocated by the Major Incident Medical Management (MIMMS) Course categorises casualties by ability to walk, respiratory rate (RR) and heart rate (HR) or capillary refill time. The military version (MS) includes assessment of consciousness...
The importance of health service planning for major incident management has been recognised since the World Trade Centre attacks of September 2001 and is highly relevant to planning for the 2012 Olympics. UK national Major Incident guidance stipulates the use of a system of triage for casualties to prioritise treatment and ensure “the greatest good for the greatest number”. However, at least three...
Triage is an important aspect of the management of mass casualty incidents. This study describes the triage after the Turkish Airlines Crash near Amsterdam in 2009. The results of the triage and the injuries of P3 casualties were evaluated. In addition, the role of the trauma mechanism and its effect on spinal immobilisation during transport was analysed.Retrospective analysis of investigational reports,...
Traumatic brain injury is common. Guidelines from the Brain Trauma Foundation and the Scottish Intercollegiate Guidelines Network recommend that patients with suspected severe traumatic brain injury should be treated in centres with neurosurgical expertise. Scotland does not have a framework for the delivery of trauma care. The aim of this study was to examine the demographic characteristics of incidents...
Current literature on motor vehicle accidents (MVAs) has few reports regarding field factors that predict the degree of injury. Also, studies of mechanistic factors rarely consider concurrent predictive effects of on-scene patient physiology. The New Injury Severity Score (NISS) has previously been found to correlate with mortality, need for ICU admission, length of hospital stay, and functional recovery...
For optimal treatment of trauma patients it is of great importance to identify patients who are at risk for severe injuries. The Dutch field triage protocol for trauma patients, the LPA (National Protocol of Ambulance Services), is designed to get the right patient, in the right time, to the right hospital. Purpose of this study was to determine diagnostic accuracy and compliance of this triage protocol...
To describe the association between increasing age, pre-hospital triage destination compliance, and patient outcomes for adult trauma patients.A retrospective data review was conducted of adult trauma patients attended by Ambulance Victoria (AV) between 2007 and 2011. AV pre-hospital data was matched to Victorian State Trauma Registry (VSTR) hospital data. Inclusion criteria were adult patients sustaining...
Major Incidents (MI) occur frequently and their unpredictable nature makes prospective research difficult and largely unethical. A key step in MI management is triage; the identification of the critically injured. Within a MI environment this is commonly performed using simple physiological ‘tools’, such as the Triage Sieve (TS). However the most commonly used tools appear to lack an evidence base...
The detection of occult or unpredictable injuries in motor vehicle crashes (MVCs) is crucial in correctly triaging patients and thus reducing fatalities. The purpose of the study was to develop a metric that indicates the likelihood that an injury sustained in a MVC would require management at a Level I/II trauma centre (TC) versus a non-trauma centre (non-TC).Transfer Scores (TSs) were computed for...
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