Retrospective Assessment of Referral of a Major Trauma Patient

Recruiting

• Conditions: Trauma Injury

• Registration Number: NCT06551350
• Lead Sponsor: Hôpital NOVO

Brief Summary

The aim of this study is to find out whether major trauma patients from the Val d'Oise are referred to the appropriate trauma centre for their care and to assess the quality of triage within the Val d'Oise department.

Detailed Description

In France, the number of major trauma is estimated at between 15,000 and 20,000 per year. It is the leading cause of death in patients under the age of 40, and is a significant source of long-term dependency. Mortality from severe trauma varies depending on the region and the circumstances of the accident. Effective initial care and referral to specialist trauma centres are crucial to improving survival. Access to these centres must be guaranteed throughout France. Trauma centres play a central role in the management of serious trauma patients. They are classified by level, from level I to level III.

The triage process aims to direct the patient to the trauma centre with the appropriate level of care. The challenge is to send the "right patient to the right place at the right time". Over-triage and under-triage are two critical concepts in the management of trauma patients. Over-triage (patients considered to be more seriously injured than they really are) leads to excessive consumption of resources and increases waiting times for patients who really need a level I or II trauma centre. Under-triage (patients considered to be less seriously injured than they really are), is characterised by patients being referred to a trauma centre that is insufficiently equipped for their needs, compromises their chances of survival and recovery. In both cases, the loss of chance for the patient is real.

The aim of this study is to find out whether major trauma patients from the Val d'Oise are referred to the appropriate trauma centre for their care, and to assess the quality of triage within the Val d'Oise department.

Study Timeline

• Study First Submitted: 2024-08-09
• Study First Submitted QC: 2024-08-09
• Study First Posted: 2024-08-13
• Study Start: 2024-10-18
• Status Verified: 2024-12
• Last Update Submitted: 2024-12-04
• Last Update Posted: 2024-12-05
• Primary Completion: 2025-05
• Study Completion: 2025-05

Recruitment & Eligibility

• Status: RECRUITING
• Sex: All
• Target Recruitment: 461

Inclusion Criteria

Not provided

Exclusion Criteria

Not provided

Study & Design

• Study Type: OBSERVATIONAL
• Study Design: Not specified

Primary Outcome Measures

Name	Time	Method
Triage assessment of a major trauma patient	At the end of the study, an average of 9 month	The criterion is the evaluation of the referral of the major trauma patient after post-Medics injury assessment into over, normo and under-triage; The over-triage patient is referred to a level I trauma centre with an Injury Severity Score (ISS) \<16; The normo-triage patients are either referred to: * a level 1 trauma centre with an ISS \>15; * the local scanner and then to an intensive care unit at the scanner site; * in the emergency department and then to a surgical unit; * emergency with a return home afterwards; The under-triage patient is either referred to: * the local scanner and then to a level 1 trauma centre; * initially emergency with hospitalisation in an intensive care or continuing care unit afterwards

Secondary Outcome Measures

Name	Time	Method
Assess if presumed alcohol intoxication is correlated with a higher rate of under-triage	At the end of the study, an average of 9 month	The correlation will be assessed by the proportion of patients under-triaged in patients with suspected alcohol intoxication. Presence of suspected alcohol intoxication assessed clinically i.e. the ratio between the number of under-triaged patients with suspected alcohol intoxication and the total number of major trauma patients
Assess if the TRENAU grade is predictive in pre-hospital of an appropriate referral following an intra-hospital trauma assessment	At the end of the study, an average of 9 month	The criterion will be assessed by the correlation between TRENAU grade and level of trauma centre for final admission : TRENAU A in a level 1 trauma centre TRENAU B in a level 2 trauma centre TRENAU C in a level 3 trauma centre The TRENAU grade (Trauma System du Réseau Nord Alpin des Urgences) is used to classify major trauma patients into 3 categories (A, B and C) in the pre-hospital phase, so that they can be referred to the appropriate level of hospital
Assess if the positive Shock-Index is predictive of an appropriate pre-hospital referral to a level 1 trauma centre	At the end of the study, an average of 9 month	The criterion will be assessed by the number of patient with positive Shock-Index (≥ 0.9) at the time of MCIU care referred to a level 1 trauma centre (final admission)
Assess if the MGAP is predictive of an appropriate referral following an intra-hospital trauma assessment	At the end of the study, an average of 9 month	The evaluation criterion will be assessed as follow : Number of patient with a MGAP between 23 and 29 and an final admission in a level 3 trauma centre Number of patient with a MGAP between 18 and 22 and an final admission in a level 2 trauma centre Number of patient with a MGAP \< 18 and an final admission in a level 3 trauma centre The MGAP score (Mechansim, Glasgow, Age, Arterial pressure) can predict the risk of in-hospital death in trauma patients. Three risk groups have been defined: low (23-29 points), intermediate (18-22 points) and high (\<18 points).
Assess if the intervention time is correlated with an under-triage	At the end of the study, an average of 9 month	The correlation will be assessed by the proportion of patients under-triaged during the following hours: * 7am to 9am; * From 6pm to 9pm; * From 9pm to 7am i.e. the ratio between the number of under-triaged patients and the number of major trauma patients treated during the defined time slots.
Assess if deliberate toxic poisoning is correlated with a higher rate of under-triage	At the end of the study, an average of 9 month	The correlation will be assessed by the proportion of patients under-triaged in patients with suspected deliberate toxic poisoning. Presence of deliberate toxic poisoning assessed clinically i.e. the ratio between the number of under-triaged patients with suspected deliberate toxic poisoning and the total number of major trauma patients
Assess if the positive Shock-Index ( ≥ 0.9 ) is predictive of an intra-hospital blood transfusion	At the end of the study, an average of 9 month	The criterion will be assessed by the number of patient with positive Shock-Index (≥ 0.9) at the time of MCIU care and who have had an intra-hospital blood transfusion

Trial Locations

Locations (1)

Resuscitation Services (SAMU 95/SMUR) - Hôpital NOVO -Pontoise Site; 🇫🇷 Pontoise, France