Establishment of a novel triage system for SARS-CoV-2 among trauma victims in trauma centers with limited facilities

Hossein Abdolrahimzadeh Fard; Roham Borazjani; Golnar Sabetian; Zahra Shayan; Shahram Boland Parvaz; Hamid Reza Abbassi; Shiva Aminnia; Maryam Salimi; Shahram Paydar; Ali Taheri Akerdi; Masome Zare; Leila Shayan; Salahaddin Mahmudi-Azer

doi:10.1136/tsaco-2021-000726

Establishment of a novel triage system for SARS-CoV-2 among trauma victims in trauma centers with limited facilities

Trauma Surg Acute Care Open. 2021 Jun 16;6(1):e000726. doi: 10.1136/tsaco-2021-000726. eCollection 2021.

Affiliations

¹ Trauma Research Center, Shahid Rajaee (Emtiaz) Trauma Hospital, Shiraz University of Medical Sciences, Shiraz, Iran.
² Department of Intensive Care Medicine, Trauma Research Center, Shahid Rajaee (Emtiaz) Hospital, Shiraz University of Medical Sciences, Shiraz, Iran.
³ Trauma Research Center, Department of Biostatistic, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran.
⁴ Student Research Commiittee, Shiraz University of Medical Sciences, Shiraz, Iran.
⁵ Trauma Intensive Care Unite, Trauma Research Center, Shahid Rajaee (Emtiaz) Trauma Hospital, Shiraz University of Medical Sciences, Shiraz, Iran.

Abstract

Objectives: The triage of trauma patients with potential COVID-19 remains a major challenge given that a significant number of patients may be asymptomatic or pre-symptomatic. This study aimed to compare the specificity and sensitivity of available triage systems for COVID-19 among trauma patients. Furthermore, it aimed to develop a novel triage system for SARS-CoV-2 detection among trauma patients in centers with limited resources.

Methods: All patients referred to our center from February to May 2020 were enrolled in this prospective study. We evaluated the SARS-CoV-2 triage protocols from the WHO, the Iranian Ministry of Health and Medical Education (MOHME), and the European Centre for Disease Control and Prevention (ECDC) for their effectiveness in finding COVID-19 infected individuals among trauma patients. We then used these data to design a stepwise triage protocol to detect COVID-19 positive patients among trauma patients.

Results: According to our findings, the WHO protocol showed 100% specificity and 13.3% sensitivity. The MOHME protocol had 99% specificity and 23.3% sensitivity. While the ECDC protocol showed 93.3% sensitivity and 89.5% specificity, it did not prioritize patients based on traumatic injuries and unstable conditions. Our stepwise triage protocol, which prioritizes traumatic injuries, had 93.3% sensitivity and 90.3% specificity.

Conclusion: Our study shows that the triage protocols from the WHO, MOHME and ECDC are not best equipped to diagnose SARS-CoV-2 infected individuals among trauma patients. In our proposed stepwise triage system, patients are triaged according to their hemodynamic conditions, COVID-19 related clinical states, and COVID-19 related laboratory findings. Our triage model can lead to more accurate and resource-effective management of trauma patients with potential COVID-19 infection.

Level of evidence: Level Ⅲ.

Keywords: COVID-19; diagnosis; multiple trauma; triage.