Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2023 Mar 21:15:79-91.
doi: 10.2147/OAEM.S403545. eCollection 2023.

Accuracy of Trauma on Scene Triage Screening Tool (Shock Index, Reverse Shock Index Glasgow Coma Scale and National Early Warning Score) to Predict the Severity of Emergency Department Triage: A Retrospective Cross-Sectional Study

Chaiyaporn Yuksen  1 , Chuenruthai Angkoontassaneeyarat  1 , Sorawat Thananupappaisal  1 , Thanakorn Laksanamapune  1 , Malivan Phontabtim  1 , Pamorn Namsanor  1
Affiliations

Accuracy of Trauma on Scene Triage Screening Tool (Shock Index, Reverse Shock Index Glasgow Coma Scale and National Early Warning Score) to Predict the Severity of Emergency Department Triage: A Retrospective Cross-Sectional Study

Chaiyaporn Yuksen et al. Open Access Emerg Med. .

Abstract

Introduction: Prehospital trauma care includes on-scene assessments, essential treatment, and facilitating transfer to an appropriate trauma center to deliver optimal care for trauma patients. While the Simple Triage and Rapid Treatment (START), Revised Triage Sieve (rTS), and National Early Warning Score (NEWS) tools are user-friendly in a prehospital setting, there is currently no standardized on-scene triage protocol in Thailand Emergency Medical Service (EMS). Therefore, this study aims to evaluate the precision of these tools (SI, rSIG, and NEWS) in predicting the severity of trauma patients who are transferred to the emergency department (ED).

Methods: This study was a retrospective cross-sectional and diagnostic research conducted on trauma patients transferred by EMS to the ED of Ramathibodi Hospital, a university-affiliated super tertiary care hospital in Bangkok, Thailand, from January 2015 to September 2022. We compared the on-scene triage tool (SI, rSIG, and NEWS) and ED triage tool (Emergency Severity Index) parameters, massive transfusion protocol (MTP), and intensive care unit (ICU) admission with the area under ROC (univariable analysis) and diagnostic odds ratio (multivariable logistic regression analysis). The optimal cut-off threshold for the best parameter was determined by selecting the value that produced the highest area under the ROC curve.

Results: A total of 218 patients were traumatic patients transported by EMS to the ED, out of which 161 were classified as ESI levels 1-2, while the remaining 57 patients were categorized as levels 3-5 on the ESI triage scale. We found that NEWS was a more accurate triage tool to discriminate the severity of trauma patients than rSIG and SI. The area under the ROC was 0.74 (95% CI 0.70-0.79) (OR 18.98, 95% CI 1.06-337.25), 0.65 (95% CI 0.59-0.70) (OR 1.74, 95% CI 0.17-18.09) and 0.58 (95% CI 0.52-0.65) (OR 0.28, 95% CI 0.04-1.62), respectively (P-value <0.001). The cut point of NEWS to discriminate ESI levels 1-2 and levels 3-5 was >6 points.

Conclusion: NEWS is the best on-scene triage screening tool to predict the severity at the emergency department, massive transfusion protocol (MTP), and intensive care unit (ICU) admission compared with other triage tools SI and rSIG.

Keywords: emergency departments; emergency medical services; prehospital care; trauma severity index; triage.

PubMed Disclaimer

Conflict of interest statement

The authors declare that they have no competing interests.

Figures

Figure 1
Figure 1
Receiver operating characteristic curve for ESI level I-2.
Figure 2
Figure 2
Receiver operating characteristic curve for intensive care unit (ICU) admission.
Figure 3
Figure 3
Receiver operating characteristic curve for massive transfusion protocol (MTP) activation.
See this image and copyright information in PMC

Similar articles

See all similar articles

Cited by

See all "Cited by" articles

References

    1. Kondo Y, Fukuda T, Uchimido R, et al. Advanced life support vs basic life support for patients with trauma in prehospital settings: a systematic review and meta-analysis. Front Med. 2021;8:660367. doi:10.3389/fmed.2021.660367 - DOI - PMC - PubMed
    1. Hansen J, Rasmussen LS, Steinmetz J. Prehospital triage of trauma patients before and after implementation of a regional triage guideline. Injury. 2022;53(1):54–60. doi:10.1016/j.injury.2021.10.011 - DOI - PubMed
    1. Bhaumik S, Hannun M, Dymond C, et al. Prehospital triage tools across the world: a scoping review of the published literature. Scand J Trauma Resusc Emerg Med. 2022;30(1):32. doi:10.1186/s13049-022-01019-z - DOI - PMC - PubMed
    1. The American College of Surgeons Committee on Trauma. Resources for optimal care of the injured patient; 2014. Available from: https://www.facs.org/media/yu0laoqz/resources-for-optimal-care.pdf. Accessed March 17, 2023.
    1. Suryanto PV, Boyle M. EMS systems in lower-middle income countries: a literature review. Prehosp Disaster Med. 2017;32(1):64–70. doi:10.1017/S1049023X1600114X - DOI - PubMed