Abstract
Introduction: Prehospital triage is a crucial step in the management of trauma patients, as it can impact outcomes by ensuring patients are directed to the most suitable treatment facility. The use of validated triage tools like the Vittel criteria and ISS is essential to support this process and improve patient care.
The aim of this study is to simplify the version of the French Vittel score in pre hospital trauma patients within the Center-Est territory of Tunisia, between November 2021 and 2023.
Methods: A longitudinal analytical study on trauma patients transported by the Emergency Medical Service (EMS) teams of the Tunisian EMS03 over a two-year period from November 2021 to November 2023. Socio- demographic and clinical data were collected using a predefined questionnaire, and the Vittel score, and ISS were calculated for each patient. Statistical tests led to the formation of three alternative algorithms. The Vittel algorithm was compared to the three alternative algorithms using the Delong et al. method.
Results: Men in their thirties were particularly prone to trauma (83.5% male with a sex ratio of 5.3), mainly due to road traffic accidents (77.2%). Blunt trauma was the predominant mechanism of injury (47.3%), followed by penetrating trauma (15.6%). Among the 461 trauma patients included in the study, 41% had an ISS greater than 15, 25% were admitted to the intensive care unit, and 23.9% died within 30 days of transfer. In the multivariate analysis, no kinetic-related criteria showed a significant correlation with ISS > 15, 30-day mortality, or ICU admission. However, three categories of the French Vittel score - physiological variables, prehospital resuscitation, and physical injuries - were significant indicators of major trauma (ISS > 15), unlike kinetic elements which lacked this predictive ability.
Conclusion: the study highlights the importance of coordination between prehospital and hospital care, and the potential of a simplified Vittel score to predict severe trauma. However, challenges remain in prehospital triage, underscoring the need for continued research and evaluation to improve trauma patient management.