Vittel criteria for severe trauma triage: Characteristics of over-triage

• Published in: Anaesthesia critical care & pain medicine 2016-04, Vol.35 (2), p.87-92
• Main Authors: Cotte, Jean, Courjon, Fredrik, Beaume, Sébastien, Prunet, Bertrand, Bordes, Julien, N’Guyen, Cédric, Contargyris, Claire, Lacroix, Guillaume, Montcriol, Ambroise, Kaiser, Eric, Meaudre, Eric
• Format: Article
• Language: English
• Subjects: Adult; Aged; Anesthesia & Perioperative Care; Angiography; Critical Care; Female; Fractures, Bone - diagnostic imaging; Fractures, Bone - surgery; Fractures, Closed - diagnostic imaging; Fractures, Closed - surgery; Humans; Longevity; Male; Middle Aged; Retrospective Studies; Severe trauma; Thoracic Injuries - diagnostic imaging; Thoracic Injuries - therapy; Trauma Centers; Triage; Triage - standards; Vittel criteria; Whole Body Imaging; Wounds and Injuries - diagnostic imaging; Wounds and Injuries - surgery; Wounds and Injuries - therapy
• ISSN: 2352-5568; 2352-5568
• DOI: 10.1016/j.accpm.2015.06.013

Abstract Aim Over-triage rates related to the use of Vittel criteria are unknown. We compared severe stable trauma patients with and without significant visceral injuries. Study design A single-centre retrospective analysis of a single-centre prospective cohort. Patients and methods Trauma patients with at least one positive Vittel criterion from June 2010 to January 2012 in a level-1 trauma centre. Initial management included a systematic whole-body scanner. All significant lesions in stable trauma patients were recorded. Results A total of 252 trauma patients were admitted. One hundred and twenty were stable. In this group without vital distress, 72 (60%) had at least one occult lesion, 21 (17.5%) had an isolated orthopaedic injury and 27 (22.5%) had no injury. Thoracic injuries accounted for 44% of visceral injuries, abdominal for 17%, spinal for 16% and cerebral for 15%. Overall, the over-triage rate was 19%. Surgery for significant visceral injury was performed in 13 patients (18%) and arteriography in 4 patients (5.5%). Admission in an intensive care unit was required for 13 patients with occult injuries and for one patient without such a lesion (18% versus 2%, P = 0.008). Hospital stays were longer in the group with visceral injuries (4 ± 7 versus 9 ± 8 days; P = 0.006). Conclusion Vittel criteria use in trauma patients induces an acceptable over-triage rate. A large proportion of stable trauma patients have occult lesions. These visceral injuries frequently require special care. These data highlight the imperative need to transport major trauma patients immediately to a dedicated trauma centre and supports whole-body scanner use.