Accuracy of pre-hospital triage tools for major trauma: a systematic review with meta-analysis and net clinical benefit
Abstract Background We conducted a systematic review to evaluate and compare the accuracy of pre-hospital triage tools for major trauma in the context of the development of the Italian National Institute of Health guidelines on major trauma integrated management. Methods PubMed, Embase, and CENTRAL...
| Main Authors: | , , , , , , , , , , , , , , , , , |
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| Format: | Article |
| Language: | English |
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BMC
2021-06-01
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| Series: | World Journal of Emergency Surgery |
| Subjects: | |
| Online Access: | https://doi.org/10.1186/s13017-021-00372-1 |
| _version_ | 1818442178178842624 |
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| author | Silvia Gianola Greta Castellini Annalisa Biffi Gloria Porcu Andrea Fabbri Maria Pia Ruggieri Nino Stocchetti Antonello Napoletano Daniela Coclite Daniela D’Angelo Alice Josephine Fauci Laura Iacorossi Roberto Latina Katia Salomone Shailvi Gupta Primiano Iannone Osvaldo Chiara the Italian National Institute of Health guideline working group |
| author_facet | Silvia Gianola Greta Castellini Annalisa Biffi Gloria Porcu Andrea Fabbri Maria Pia Ruggieri Nino Stocchetti Antonello Napoletano Daniela Coclite Daniela D’Angelo Alice Josephine Fauci Laura Iacorossi Roberto Latina Katia Salomone Shailvi Gupta Primiano Iannone Osvaldo Chiara the Italian National Institute of Health guideline working group |
| author_sort | Silvia Gianola |
| collection | DOAJ |
| description | Abstract Background We conducted a systematic review to evaluate and compare the accuracy of pre-hospital triage tools for major trauma in the context of the development of the Italian National Institute of Health guidelines on major trauma integrated management. Methods PubMed, Embase, and CENTRAL were searched up to November 2019 for studies investigating pre-hospital triage tools. The ROC (receiver operating characteristics) curve and net clinical benefit for all selected triage tools were performed. Quality assessment was performed using the Quality Assessment of Diagnostic Accuracy Studies–2. Certainty of the evidence was judged with the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach. Results We found 15 observational studies of 13 triage tools for adults and 11 for children. In adults, according to the 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-hospital triage tool with the best net clinical benefit trajectory was the New Trauma Score (NTS) < 18 (Sn, 0.82; Sp, 0.86; 1 study; sample size, 1001; moderate certainty of the evidence). In children, high variability among all triage tools for sensitivity and specificity was found. Conclusion Sensitivity and specificity varied across all available pre-hospital trauma triage tools. TRENAU and NTS are the best accurate triage tools for adults, whereas in the pediatric area a large variability prevents any firm conclusion. |
| first_indexed | 2024-12-14T18:40:01Z |
| format | Article |
| id | doaj.art-a223d600f2fa48e9be02aafef25bae32 |
| institution | Directory Open Access Journal |
| issn | 1749-7922 |
| language | English |
| last_indexed | 2024-12-14T18:40:01Z |
| publishDate | 2021-06-01 |
| publisher | BMC |
| record_format | Article |
| series | World Journal of Emergency Surgery |
| spelling | doaj.art-a223d600f2fa48e9be02aafef25bae322022-12-21T22:51:31ZengBMCWorld Journal of Emergency Surgery1749-79222021-06-0116111110.1186/s13017-021-00372-1Accuracy of pre-hospital triage tools for major trauma: a systematic review with meta-analysis and net clinical benefitSilvia Gianola0Greta Castellini1Annalisa Biffi2Gloria Porcu3Andrea Fabbri4Maria Pia Ruggieri5Nino Stocchetti6Antonello Napoletano7Daniela Coclite8Daniela D’Angelo9Alice Josephine Fauci10Laura Iacorossi11Roberto Latina12Katia Salomone13Shailvi Gupta14Primiano Iannone15Osvaldo Chiara16the Italian National Institute of Health guideline working groupUnit of Clinical Epidemiology, IRCCS Istituto Ortopedico GaleazziUnit of Clinical Epidemiology, IRCCS Istituto Ortopedico GaleazziNational Centre for Healthcare Research and Pharmacoepidemiology, Department of Statistics and Quantitative Methods, University of Milano-BicoccaNational Centre for Healthcare Research and Pharmacoepidemiology, Department of Statistics and Quantitative Methods, University of Milano-BicoccaEmergency Department, AUSL della RomagnaEmergency Department, AO San Giovanni AddolorataDepartment of Pathophysiology and Transplantation, University of MilanCentro Eccellenza Clinica Qualità e Sicurezza delle Cure, Istituto Superiore di SanitàCentro Eccellenza Clinica Qualità e Sicurezza delle Cure, Istituto Superiore di SanitàCentro Eccellenza Clinica Qualità e Sicurezza delle Cure, Istituto Superiore di SanitàCentro Eccellenza Clinica Qualità e Sicurezza delle Cure, Istituto Superiore di SanitàCentro Eccellenza Clinica Qualità e Sicurezza delle Cure, Istituto Superiore di SanitàCentro Eccellenza Clinica Qualità e Sicurezza delle Cure, Istituto Superiore di SanitàCentro Eccellenza Clinica Qualità e Sicurezza delle Cure, Istituto Superiore di SanitàAdams Cowley Shock Trauma Center, University of MarylandCentro Eccellenza Clinica Qualità e Sicurezza delle Cure, Istituto Superiore di SanitàDepartment of Pathophysiology and Transplantation, University of MilanAbstract Background We conducted a systematic review to evaluate and compare the accuracy of pre-hospital triage tools for major trauma in the context of the development of the Italian National Institute of Health guidelines on major trauma integrated management. Methods PubMed, Embase, and CENTRAL were searched up to November 2019 for studies investigating pre-hospital triage tools. The ROC (receiver operating characteristics) curve and net clinical benefit for all selected triage tools were performed. Quality assessment was performed using the Quality Assessment of Diagnostic Accuracy Studies–2. Certainty of the evidence was judged with the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach. Results We found 15 observational studies of 13 triage tools for adults and 11 for children. In adults, according to the 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-hospital triage tool with the best net clinical benefit trajectory was the New Trauma Score (NTS) < 18 (Sn, 0.82; Sp, 0.86; 1 study; sample size, 1001; moderate certainty of the evidence). In children, high variability among all triage tools for sensitivity and specificity was found. Conclusion Sensitivity and specificity varied across all available pre-hospital trauma triage tools. TRENAU and NTS are the best accurate triage tools for adults, whereas in the pediatric area a large variability prevents any firm conclusion.https://doi.org/10.1186/s13017-021-00372-1Systematic reviewMajor traumaTriagePre-hospital, Accuracy |
| spellingShingle | Silvia Gianola Greta Castellini Annalisa Biffi Gloria Porcu Andrea Fabbri Maria Pia Ruggieri Nino Stocchetti Antonello Napoletano Daniela Coclite Daniela D’Angelo Alice Josephine Fauci Laura Iacorossi Roberto Latina Katia Salomone Shailvi Gupta Primiano Iannone Osvaldo Chiara the Italian National Institute of Health guideline working group Accuracy of pre-hospital triage tools for major trauma: a systematic review with meta-analysis and net clinical benefit World Journal of Emergency Surgery Systematic review Major trauma Triage Pre-hospital, Accuracy |
| title | Accuracy of pre-hospital triage tools for major trauma: a systematic review with meta-analysis and net clinical benefit |
| title_full | Accuracy of pre-hospital triage tools for major trauma: a systematic review with meta-analysis and net clinical benefit |
| title_fullStr | Accuracy of pre-hospital triage tools for major trauma: a systematic review with meta-analysis and net clinical benefit |
| title_full_unstemmed | Accuracy of pre-hospital triage tools for major trauma: a systematic review with meta-analysis and net clinical benefit |
| title_short | Accuracy of pre-hospital triage tools for major trauma: a systematic review with meta-analysis and net clinical benefit |
| title_sort | accuracy of pre hospital triage tools for major trauma a systematic review with meta analysis and net clinical benefit |
| topic | Systematic review Major trauma Triage Pre-hospital, Accuracy |
| url | https://doi.org/10.1186/s13017-021-00372-1 |
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