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Abstract Background In regional trauma systems, emergency medical service (EMS) providers play a crucial role by performing prehospital triage for severely injured patients and transporting them to regional trauma centres. Since 2016, a regional trauma centre has provided prehospital medical guidance to EMS providers through a trauma hotline, facilitated by trauma surgeon, to guide field triage, treatment, and transport. This study analysed the effects and clinical outcomes of a regional trauma centre-led performance improvement program that followed closed-loop principles for EMS providers. Methods Data from the regional trauma centre databases (2016–2021) were collected, and patients with trauma with Injury Severity Scores (ISSs) > 15 in the Gyeonggi Province who were injured, regardless of whether they visited the trauma centre directly or not, were included. After severity and baseline demographic adjustments through propensity score matching, clinical outcomes were analysed using the t-test and chi-squared test, and the results were expressed as medians with interquartile ranges (IQRs) or means with standard deviations (SDs). Results We included 3017 patients from the 6-year study period. Correct triage and undertriage were performed in 2528 and 489 patients, respectively. Prehospital medical guidance and feedback were provided 432 times (32.1%) in 2016 and increased to 1505 times (96.8%) in 2021 (p p p < 0.001). After propensity score matching, 484 correctly triaged and 484 undertriaged patients were identified for subgroup analyses. The in-hospital mortality of undertriaged and correctly triaged patients was 20% (n = 99) and 13% (n = 61) (p = 0.001), respectively. The median (IQR) for undertriaged over correctly-triaged patients regarding hospital length of stay (LOS) and ICU day ratio was 17 (8–37) vs 19 (12–36) (p = 0.024) and 0.4 (0.2-1.0) vs 0.3 (0.2–0.6) (p = 0.059), respectively. Conclusion Undertriage was associated with increased in-hospital mortality and hospital LOS. There was a statistically significant difference between the increase in prehospital medical guidance and the decreased undertriage rate. Specifically, in the early stages of regional trauma-system development, the trauma center-led trauma hotline feedback and case-based education programs can be effective models to facilitate prehospital patient triage and patient centralisation.
Choi et al. (Wed,) studied this question.