Retrospective Assessment of Referral of a Major Trauma Patient
NCT Number: NCT06551350
Acronym: SAMU-TRAUMAS
Status: NOT_YET_RECRUITING
Study Type: OBSERVATIONAL
Conditions: Trauma Injury
Interventions: OTHER: Data Collection
Sponsor: Hôpital NOVO
Sex: ALL
Age: ADULT, OLDER_ADULT
Enrollment: 461
Study Design: Observational Model: |Time Perspective: p
Start Date: 2024-08
Completion Date: 2025-05
Locations: Resuscitation Services (SAMU 95/SMUR) - Hôpital NOVO -Pontoise Site, Pontoise, 95300, France

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.

Primary Outcome Measures: Triage assessment of a major trauma patient, 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, At the end of the study, an average of 9 month
Secondary Outcome Measures: Assess if the intervention time is correlated with an under-triage, 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., At the end of the study, an average of 9 month|Assess if presumed alcohol intoxication is correlated with a higher rate of under-triage, 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, At the end of the study, an average of 9 month|Assess if deliberate toxic poisoning is correlated with a higher rate of under-triage, 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, At the end of the study, an average of 9 month|Assess if the TRENAU grade is predictive in pre-hospital of an appropriate referral following an intra-hospital trauma assessment, 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, At the end of the study, an average of 9 month|Assess if the positive Shock-Index is predictive of an appropriate pre-hospital referral to a level 1 trauma centre, 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), At the end of the study, an average of 9 month|Assess if the positive Shock-Index ( ≥ 0.9 ) is predictive of an intra-hospital blood transfusion, 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, At the end of the study, an average of 9 month|Assess if the MGAP is predictive of an appropriate referral following an intra-hospital trauma assessment, 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)., At the end of the study, an average of 9 month