Studies Evaluating Current Field Triage: 1966—2005

Abstract

The American College of Surgeons (ACS) field triage guidelines are used to determine which patients require prompt transport to a trauma center andwhich can be transported to a lower-level facility. The objective of this report was to conduct a literature review to determine the sensitivity andspecificity of the ACS field triage criteria andeach step of the criteria. The bibliographic database MEDLINE was used to conduct a literature search for relevant English-language articles published between 1966 and2005. The search was conducted by combining the Medical Subject Headings (MeSH) “emergency medical services,” “triage,” and“wounds andinjury.” To ensure that the search was comprehensive, the reference sections of all selected articles were searched for additional relevant references andsearches by other organizations were reviewed to identify additional relevant articles. The MEDLINE search identified 542 titles. The author reviewed the titles, and107 abstracts were selected for further review. Through the MEDLINE search, the reference section review, andthe review of other searches, 80 articles were identified as relevant. Of those, five studies evaluated the full ACS criteria. Two of these calculated the specificity (8%) and/or sensitivity (95%–97%) of the ACS criteria. The remaining studies looked at the percentage of patients transported or admitted to a trauma center. Three studies looked at the predictive value of the physiologic step, andone of these calculated the sensitivity (56%) andspecificity (86%). Two studies specifically analyzed the anatomic step. One of these calculated the sensitivity (45%). This search found that there is insufficient evidence to support the overall ACS field triage criteria. However, of the various steps, the physiologic andanatomic steps had the best evidence to support them.

Key words:

• emergency medical services
• trauma
• emergency medical technician
• triage.