We conducted a systematic review to evaluate and compare the accuracy of pre-hospital triage tools for major trauma in the context of the development of the Italian National Institute of Health guidelines on major trauma integrated management. PubMed, Embase, and CENTRAL were searched up to November 2019 for studies investigating pre-hospital triage tools. The ROC (receiver operating characteristics) curve and net clinical benefit for all selected triage tools were performed. Quality assessment was performed using the Quality Assessment of Diagnostic Accuracy Studies–2. Certainty of the evidence was judged with the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach. We found 15 observational studies of 13 triage tools for adults and 11 for children. In adults, according to the ROC curve and the net clinical benefit, the most reliable tool was the Northern French Alps Trauma System (TRENAU), adopting injury severity score (ISS) > 15 as reference (sensitivity (Sn), 0.92; specificity (Sp), 0.41; 1 study; sample size, 2572; high certainty of the evidence). When mortality as reference was considered, the pre-hospital triage tool with the best net clinical benefit trajectory was the New Trauma Score (NTS) < 18 (Sn, 0.82; Sp, 0.86; 1 study; sample size, 1001; moderate certainty of the evidence). In children, high variability among all triage tools for sensitivity and specificity was found. Sensitivity and specificity varied across all available pre-hospital trauma triage tools. TRENAU and NTS are the best accurate triage tools for adults, whereas in the pediatric area a large variability prevents any firm conclusion.

中文翻译：

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重大创伤院前分诊工具的准确性：荟萃分析和净临床效益的系统评价


我们在意大利国立卫生研究院制定重大创伤综合管理指南的背景下进行了系统评价，以评估和比较重大创伤院前分诊工具的准确性。截至 2019 年 11 月，PubMed、Embase 和 CENTRAL 均检索了调查院前分诊工具的研究。对所有选定的分类工具进行了 ROC（接受者操作特征）曲线和净临床效益。使用诊断准确性研究质量评估–2 进行质量评估。证据的确定性通过建议评估、制定和评价分级（GRADE）方法进行判断。我们发现了 15 项观察性研究，涉及 13 种成人分类工具和 11 种儿童分类工具。在成人中，根据ROC曲线和临床净效益，最可靠的工具是法国北阿尔卑斯山创伤系统（TRENAU），采用损伤严重程度评分（ISS）> 15作为参考（敏感性（Sn），0.92；特异性（ Sp)，0.41；1 项研究；证据质量高；当考虑死亡率作为参考时，具有最佳净临床效益轨迹的院前分诊工具是新创伤评分 (NTS) < 18（Sn，0.82；Sp，0.86；1 项研究；样本量，1001；中等确定性证据）。在儿童中，所有分类工具的敏感性和特异性都存在很大差异。所有可用的院前创伤分诊工具的敏感性和特异性各不相同。 TRENAU 和 NTS 是成人最准确的分类工具，而在儿科领域，巨大的变异性阻碍了任何明确的结论。