APPLICATION OF AMERICAN-COLLEGE OF SURGEONS FIELD TRIAGE GUIDELINES BY PREHOSPITAL PERSONNEL

BACKGROUND: The American College of Surgeons' Committee on Trauma (ACS COT) has developed field triage guidelines intended to identify seriou sly injured patients, Unlike the 1990 version, the 1993 revision calls for on-line medical control assistance with the triage decision for p atients whose only marker of severe injury is the mechanism of their i njury, We prospectively examined the application of the 1990 ACSCOT fi eld triage guidelines to evaluate Emergency Medical Service (EMS) util ization of these guidelines and the potential effects of the 1993 revi sion, STUDY DESIGN: Emergency Medical Service personnel identified all ACSCOT criteria applicable to patients delivered to the level 1 traum a center at the Medical University of South Carolina, Trauma registry data were used to compare actual injury severity with applicable indic ators, Patients with an injury severity score greater than or equal to 16 were considered seriously injured, The South Carolina state trauma and EMS databases were queried to estimate systemwide overtriage and undertriage rates, RESULTS: Questionnaires were completed for 753 pati ents over 19 months of study, One hundred twenty-two patients had seri ous injuries, The estimated systemwide overtriage and undertriage rate s were 2.7 and 20.3 percent, respectively, Physiologic criteria had a 64.8 percent sensitivity and a 41.8 percent positive predictive value (PPV), The addition of anatomic criteria increased sensitivity to 82.8 percent and decreased PPV to 26.9 percent, Adding mechanism of injury increased sensitivity to 95.1 percent but further reduced PPV to 18.2 percent, Review of EMS records suggests that the addition of on-line medical control for patients in whom only the mechanism of injury tria ge guidelines apply could improve PPV with little effect on sensitivit y, CONCLUSIONS: The current ACSCOT field triage guidelines are appropr iate when applied by field EMS personnel.