Compliance with prehospital triage protocols for major trauma patients

Background: The extent to which severely injured patients receive definitiv e care at trauma centers is determined by the accuracy of prehospital major trauma criteria in predicting severe injuries and by the level of complian ce with these triage instructions by prehospital providers. This study was conducted to evaluate the level of compliance with triage criteria in an es tablished trauma system. Methods: The study involved a retrospective analysis of the 1995 Maryland s tatewide prehospital ambulance data. Prehospital providers in Maryland are instructed to consider transporting patients meeting any of the three nonex clusive major trauma criteria-physiology, injury, and mechanism-to designat ed trauma centers. Compliance with these criteria was defined as the propor tion of patients transported to designated trauma centers among those meeti ng prehospital triage criteria as documented on the ambulance trip report. Special emphasis was placed on differences in the levels of compliance by a ge of the trauma patients. Results: A total of 32,950 transports were analyzed. Patients meeting injur y. criteria were most likely to be transported to trauma centers (86%), fol lowed by those meeting mechanism criteria (46%), and physiology criteria (3 4%). When the level of compliance was stratified by age, there was no age d ifference in the level of compliance for patients meeting injury criteria ( 90.5% for patients aged 0-54 Sears vs. 88.7% for patients aged 55+ years; p = 0.197), For older patients meeting physiology criteria only or for those meeting mechanism criteria only, however, compliance was differentially io n. For patients meeting physiology criteria only, the compliance was 40.3% for patients aged 0 to 54 years and 23.9% for patients aged 55 years and ol der (p = 0.0001); for patients meeting mechanism criteria only, compliance was 47.0% for patients aged 0 to 54 years and 39.7% for patients aged 55+ y ears (p = 0.002). Conclusion: The majority of patients meeting prehospital major trauma crite ria were transported to designated trauma centers. Patients meeting only ph ysiology criteria, however, were much less likely to be transported to trau ma centers, and there was a differentially low compliance for elderly traum a patients meeting physiology criteria alone. The causes and consequences o f lower compliance with triage instructions for the elderly population dese rve further investigation.