Accuracy of pre-hospital triage tools for major trauma: a systematic review with meta-analysis and net clinical benefit

Roberto Latina, Gregorio Tugnoli, Alice Josephine Fauci, Andrea Fabbri, Carlo Coniglio, Annalisa Biffi, Gaddo Flego, Roberto Latina, Shailvi Gupta, Silvia Gianola, Greta Castellini, Elvio De Blasio, Antonello Napoletano, Claudio Tacconi, Katia Salomone, Daniela D’Angelo, Gloria Porcu, Massimo Geraci, Laura Iacorossi, Daniela CocliteFederico Santolini, Antonio Rampoldi, Osvaldo Chiara, Giulio Maccauro, Nino Stocchetti, Primiano Iannone, Maria Pia Ruggieri

Risultato della ricerca: Articlepeer review

Abstract

Background: We conducted a systematic review to evaluate and compare the accuracy of pre-hospital triage toolsfor major trauma in the context of the development of the Italian National Institute of Health guidelines on majortrauma integrated management.Methods: PubMed, Embase, and CENTRAL were searched up to November 2019 for studies investigating prehospital triage tools. The ROC (receiver operating characteristics) curve and net clinical benefit for all selected triagetools were performed. Quality assessment was performed using the Quality Assessment of Diagnostic AccuracyStudies–2. Certainty of the evidence was judged with the Grading of Recommendations Assessment, Developmentand Evaluation (GRADE) approach.Results: We found 15 observational studies of 13 triage tools for adults and 11 for children. In adults, according tothe ROC curve and the net clinical benefit, the most reliable tool was the Northern French Alps Trauma System(TRENAU), adopting injury severity score (ISS) > 15 as reference (sensitivity (Sn), 0.92; specificity (Sp), 0.41; 1 study;sample size, 2572; high certainty of the evidence). When mortality as reference was considered, the pre-hospitaltriage tool with the best net clinical benefit trajectory was the New Trauma Score (NTS) < 18 (Sn, 0.82; Sp, 0.86; 1study; sample size, 1001; moderate certainty of the evidence). In children, high variability among all triage tools forsensitivity and specificity was found.Conclusion: Sensitivity and specificity varied across all available pre-hospital trauma triage tools. TRENAU and NTSare the best accurate triage tools for adults, whereas in the pediatric area a large variability prevents any firmconclusion.
Lingua originaleEnglish
Numero di pagine11
RivistaWorld Journal of Emergency Surgery
Volume16
Stato di pubblicazionePublished - 2021

All Science Journal Classification (ASJC) codes

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