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 a 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 programme that followed closed-loop principles for EMS providers. We collected data from regional trauma centre databases (2016–2021) of patients with trauma with Injury Severity Scores > 15 in the Gyeonggi Province. The primary outcome was the undertriage rate, and the secondary outcomes were in-hospital mortality, hospital length of stay (LOS), intensive care unit LOS, and duration of mechanical ventilation. After severity and demographic adjustments through propensity score matching, clinical outcomes were analysed using the Mann–Whitney U and chi-squared test. The results were expressed as medians with interquartile ranges. Among the 3017 patients included in the 6-year study period, correct triage and undertriage were performed in 2528 and 489, respectively. From 2016 to 2021, prehospital medical guidance and feedback provision increased from 432 times (32.1%) to 1505 times (96.8%) (p < 0.001); the undertriage rate decreased from 32.7% (n = 55/168) to 6.3% (n = 52/820) (p < 0.001); and the overall mortality decreased from 21.4 to 10% (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. Undertriage of severely injured patients was associated with significantly increased mortality (20% vs. 13%, p = 0.001). Implementation of a trauma center-led education and hotline program coincided with a marked reduction in undertriage rates from 32.7 to 6.3% over the study period. These findings underscore the critical role of regional trauma centers in enhancing prehospital triage through systematic education and real-time medical guidance, particularly in the early phases of trauma system development. Special attention to elderly patients and those with comorbidities is essential for optimizing triage accuracy and reducing preventable trauma deaths.
Choi et al. (Tue,) studied this question.