The National Trauma Triage Protocol: can this tool predict which patients with trauma will benefit from helicopter transport?

BACKGROUND: Helicopter transport (HT) is an important component of American trauma care, but prospectively identifying patients that would benefit from this resource remains difficult. The objective of this study was to assess the role of the National Trauma Triage Protocol (NTTP) in selecting patients that would benefit from HT.

METHODS: Subjects transported by HT or ground transport from the scene of injury in 2007 were identified using the National Trauma Databank version 8. Criteria from the stepwise NTTP available in the data set were collected including physiologic data, anatomic injuries identified by DRG International Classification of Diseases-9th Rev. codes, and age. Subgroups of patients who met specific triage criteria were evaluated using logistic regression to determine if transport modality was an independent predictor of survival after controlling for demographics, injury severity, prehospital time, and presence of other NTTP triage criteria. Standard test characteristics were calculated for each criterion to predict trauma center need (TCN). The performance of triage criteria to predict TCN was compared between the groups using independent receiver operating characteristic area under the curve analysis.

RESULTS: There were 258,387 subjects transported either by helicopter (16%) or by ground (84%). HT subjects were more severely injured (mean [SD], Injury Severity Score, 15.9 [12] vs. 10.2 [10], p < 0.01). Logistic regression identified HT as an independent predictor of survival in subjects with a subset of triage criteria, including penetrating injury, GCS<14, RR<10 or >29 breaths per minute, and age>55 years. Each criterion previously mentioned was significantly more predictive of TCN in the HT group than in the ground transport group (p < 0.01).

CONCLUSION: Patients who meet certain triage criteria in the field seem to have an independent survival benefit if transported to a trauma center by helicopter. Furthermore, these criteria are highly specific and more reliably predict TCN in the HT group. The specific triage criteria listed previously should be carefully considered when developing policies for scene helicopter use in the trauma setting.