Assessment of the correlation between the Vittel criteria and the ISS score: A novel approach to pre-hospital severe trauma patient’s triage

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Published Dec 1, 2024
https://doi.org/10.62438/tunismed.v102i12.5198
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Vol. 102 No. 12 (2024): Tunis Med dec 2024

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Sondes Laajimi
Emergency medical service (EMS/SAMU03) Sahloul University Hospital, Faculty of Medicine of Sousse, University of Sousse, Sousse, Tunisia
https://orcid.org/0000-0003-3446-3671
Sana Bhiri
Department of Prevention and Security of Care, Sahloul University Hospital, Faculty of Medicine of Sousse, University of Sousse, Sousse, Tunisia
Nabil Chebbi
Emergency medical service (EMS/SAMU03) Sahloul University Hospital, Faculty of Medicine of Sousse, University of Sousse, Sousse, Tunisia
Haifa Bradai
Emergency medical service (EMS/SAMU03) Sahloul University Hospital, Faculty of Medicine of Sousse, University of Sousse, Sousse, Tunisia
Amal Belkhiria
Department of Prevention and Security of Care, Sahloul University Hospital, Faculty of Medicine of Sousse, University of Sousse, Sousse, Tunisia
Dorra Loghmari
Emergency medical service (EMS/SAMU03) Sahloul University Hospital, Faculty of Medicine of Sousse, University of Sousse, Sousse, Tunisia
Naoufel Chebili
Emergency medical service (EMS/SAMU03) Sahloul University Hospital, Faculty of Medicine of Sousse, University of Sousse, Sousse, Tunisia
Rabeb Mbarek
Emergency medical service (EMS/SAMU03) Sahloul University Hospital, Faculty of Medicine of Sousse, University of Sousse, Sousse, Tunisia
Mohamed Kahloul
Department of Anesthesiology and Intensive Care, Sahloul University Hospital, Faculty of Medicine of Sousse, University of Sousse, Sousse, Tunisia

Abstract

Introduction-Aim: Validated triage tools such as the Vittel criteria are essential to improve the care of trauma patients. The aim of this study was to evaluate the correlation between the Vittel triage criteria and the Injury Severity Score (ISS) to improve the accuracy of pre-hospital triage. 


Methods: We conducted a longitudinal study of all trauma patients transported by EMS over a two-year period (November 2021- November 2023). Vittel and (ISS) scores were calculated on admission. Predictive Vittel criteria were defined by independent risk factors for ISS>15 using a multiple logistic regression model with p-value < 0.05 and/or sensitivity (se) >50%, with positive Youden index (Yi).


Results: A total of 461 trauma patients were transported by EMS during the study period were included. The sex ratio was 5.3 and road traffic accidents accounted for 77.2%. An ISS>15 was found in 41% of participants, 25% required ICU admission and 23.9% died within 30 days. Using the above selection criteria, we identified seven key predictive criteria (OR CI 95%, se%, Yi) Glasgow coma scale<13(3.16 [1.91 5.24],44,0.25); fall>6 m(4.031[1.61-10.08],10,0.07); severe burn(23.89[10.21-55.93],6,0.02); Pelvic fracture (4.93 [1.19-20.32], 28, 0.25),suspected spinal cord injury(6.89 [2.79-16.96], 6, 0.05); Fluid resuscitation>1000 ml(-, 60.0. 11); Catecholamine (2.02 [1.09-3.75],51.0.27). Physiological variables (se 30%, Yi 0.16) and pre-hospital resuscitation(se 46%, Yi 0.18) were among the most relevant categories for predicting severity, similar to the full Vittel score. 


Conclusion: Seven criteria were associated with severe trauma (ISS score >15). Physiological variables and pre-hospital resuscitation were significant categories that ...(abstract truncated at 250 words).

Keywords:

trauma, triage, vittel score, injury severity score (ISS) , prehospital

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