Why a Trauma Triage App?
Analysis of all trauma patients in the Netherlands by the Dutch National Trauma Registry showed that 33% of the severely injured patients were not transported to a higher-level trauma center. Severely injured patients should be transported to a higher-level trauma center to improve their chances of survival and avert life-long disabilities.
In 2016, the National Health Care Institute of the Netherlands set the aim to achieve an undertriage rate below 10%, meaning that 90% of the severely injured patients should be transported to a higher-level trauma center. To improve the prehospital trauma triage, an algorithm was developed, based on a database including adult trauma patients in a region in the center of the Netherlands. This algorithm has been incorporated in the Trauma Triage App. The algorithm can identify over 90% of the severely injured patients.
Why is undertriage a problem?
Undertriage occurs when a severely injured patient is not transported to a higher-level trauma center. Higher-level trauma centers are capable to provide adequate care for the severely injured patients. In these centers, a specialized team is available 24/7 to treat these patients. Lower-level trauma centers are not capable to provide care for severely injured patients. It is crucial that severely injured patients are transported to higher-level trauma centers, to improve their chances of survival and avert life-long disabilities.
How accurate are prehospital triage protocols?
Similar prehospital trauma triage protocols are used worldwide. Most protocols are simple and static flowcharts, whereas patients are dynamic. A recently published review of the literature showed that none of these triage protocols was able to recognize severely injured patients accurately. In the Netherlands, the National Protocol of the Netherlands is used. Research has shown that this protocol can only identify 36% of the severely injured patients.
Does the judgment of the EMS providers contribute to the accuracy of field triage?
Absolutely. Prehospital trauma triage can be a challenging task without specialized diagnostic equipment. Even though the National Dutch triage protocol can only identify 36% of the severely injured patients, two thirds of the severely injured patients are transported to a higher-level trauma center in the Netherlands as a result of the judgment of the EMS professionals.
How does TTApp work?
The application uses an algorithm that is based on an analysis of all adult trauma patients transported by an ambulance with the highest priority (siren and lights). The algorithm uses various prehospital parameters to predict whether a patient is severely injured or not. This algorithm is incorporated in the application to make it user-friendly to use on-scene.
For which patients should the TTApp be used?
- Patients transported by an ambulance with the highest-priority (siren and lights).
- When in doubt whether the patient should be transported to a higher-level or a lower-level trauma center.
The accuracy of the TTApp in other populations (e.g. during major events) has not been investigated, so we do not recommend using the application in such settings.
Is TTApp publicly available?
The Trauma Triage App is only available for EMS providers of the Regional Ambulance Facilities in some regions in the Netherlands. In the near future, the application will be implemented in other regions. The application is not available for private use and can therefore not be found on Google Play or in the App Store.
Is TTApp based on scientific research?
The algorithm used in the application is based on epidemiological research. Based on the collected data, a new algorithm was developed to identify severe injuries. Recently, an article was published on the quality of the prehospital trauma field triage in Central-Netherlands. You can find the article here.
What will happen with the data generated from TTapp?
Various aspects of the app are tested in this study, including usability in practice, implications for patient flows and more. Based on our studies, the app will be improved continuously. The application will be adapted to each new trauma region in the future.
Would you like to use the app in your region?
If you are interested in using the application or if you require more information, please contact us via firstname.lastname@example.org.
What is the difference between Dutch and American trauma centers?
The definitions for the level division of the trauma centers differ per country. In other countries, such as in America, the higher-level trauma centers are equal to level-1 and level-2. In the Netherlands, only level-1 trauma centers have the facilities to provide optimal treatment for severely injured patients.