The ability of criteria–directed protocol versus emergency severity index and modified rapid emergency medicine score in triage of trauma

Introduction: With respect to high prevalence and high mortality of trauma in our country, Iran, triage of patient trauma is very important. Based on the country protocol, hospital emergencies use from five categories ESI (emergency severity index) in entire country. The ideal triage criteria would be 100% accurate with no under triage or over triage, however, this is not possible. We aimed to survey the ability of criteria –directed protocol versus ESI and modified rapid emergency medicine score (mREMS) in triage of trauma patients. Methods: This retrospective cross-sectional study was carried out on 120 patients admitted in Emergency department of Imam Reza hospital in 2020 and triaged by ESI and criteria–directed protocol (CDP). After study of patients, we determined the score of patients in basis of injury severity score (ISS) and mREMS. If the scores of a patient were>15 for ISS and>4 for mREMS, the patient was transmitted to cardiopulmonary resuscitation (CPR), otherwise he or she was under triaged. If the scores of a patient was<15 for ISS and<6 for mREMS the patient was transmitted to trauma section, otherwise he or she was over triaged. American surgeon college advices the total of under triaged patients should not exceed 5%. In this study we calculated under triaged patients 8.3% and over triaged 4.1%. Results: This study indicates ESI and ISS have direct connection in triage of patients. Also, CDP and ISS have direct connection in triage of patients. ESI and mREMS have not direct connection with each other. CDP and mREMS have not direct connection and they are independent. Conclusion: Absence of important indices in ESI model for triage of patients for example age, vital sign and Glasgow Coma Scale (GCS) result in under triage and this injury to patients. Thus, adding of this index in ESI causes ESI have been more efficient and decrease under triage and finally diagnostic and therapeutic actions for patients do fast and exact.