Substituting systolic blood pressure with shock index in the national trauma triage protocol.

Introduction: The National Trauma Triage Protocol (NTTP) is an algorithm that guides emergency medical service providers (EMS) through four decision steps to identify the patients that would benefit from trauma center care. NTTP defines a systolic blood pressure (SBP) =18 years of age in the NTDB was performed. Transferred patients, patients dead on arrival, and with missing data were excluded. Our outcome measure was trauma center need (TCN) defined by ISS greater than 15, need for emergent operation, death in the ED, and ICU stay > 1 day. Area under curve (AUC) and triage characteristics were compared between SBP 1.0. Logistic regression analysis was performed to compare the mortality between patients triaged under current protocol of SBP 1.0) Results: A total of 505,296 patients were included. Compared to SBP1.0 had a higher sensitivity (44.4% vs. 41.7%) but lower specificity (80.2% vs. 82.4%). The AUC [95% CI] was significantly higher for SI>1.0 (0.623 [0.622-.625] vs. 0.620 [0.619-0.622]). Substituting SBP1.0 resulted in a decrease in under-triage rate of 30,233 patients (5.9%) but an increase in over-triage of only 6,386 patients (1.3%). Conclusion: Substituting the current criteria of SBP1.0 results in significant reduction in under-triage rate without causing large increase in over-triage. Because of simplicity of use, better discrimination power, and minimal effect on overtriage rates, future studies should consider exploring the possibility of replacing the current systolic blood pressure 1.0 in the NTTP. Level of Evidence: Diagnostic study, Level IV (C) 2016 Lippincott Williams & Wilkins, Inc.

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