MATTS: Major Trauma Triage Tool Study

Plain English Summary

Background and study aims
Serious injuries are a major health problem in England, responsible for 3,000 deaths and 8,000 disabilities each year. Treatment in specialist hospitals, called major trauma centres, can improve survival following such injuries. In order to benefit from this expert care, ambulance crews must first correctly identify suitable patients at the scene of injury and then transport them to a major trauma centre, potentially bypassing closer non-specialist hospitals.

The presence of serious injury is not always obvious and assessment can be difficult. Taking patients with minor injuries to the major trauma centre could waste time, money and resources; denying treatment to those who require it by overstretching the capacity of the major trauma centre. It could also inconvenience patients and their families by taking them further from home. In contrast, failing to recognise serious injury could result in less effective treatment or increased harm.

The term ‘triage’ means to sort patients in terms of priority. Ambulance crews currently use a ‘triage tool’ to help them to recognise whether a patient is seriously injured or not. The tool is a checklist of patient and injury features, for example the presence of low blood pressure, that indicate that care in a major trauma centre care might be beneficial. Unfortunately, research has suggested that current tools are not very accurate, as they could miss patients with serious injury and often unnecessarily direct patients with more minor injuries to a major trauma centre. This study aims to develop a new and more accurate tool that will help to ensure that the right patient gets to the right place at the right time.

Who can participate?
Any patient seen by one of the 4 participating Ambulance Services, who is suspected of suffering a major trauma, will be subject to the use of the new major trauma triage tool (during the 4 month intervention phase of the study)

What does the study involve?
We will carefully study existing triage tools used in England and world-wide. We will also use data already collected by ambulance services and the English national major trauma database (the Trauma Audit and Research Network, TARN) to investigate what factors are important for detecting serious injury at the scene of the incident. Additionally we will develop a computer model that simulates the costs and outcomes of using different triage tools. Together, we will take this information to a group of experts and ask them to develop a new triage tool.

We will then test the experts’ triage tool, together with other existing tools, to see how they perform. In order to do this we will link data that is routinely collected by the Yorkshire, West Midlands, South Western and London Ambulance services, with hospital information collected by TARN. It has been suggested that identifying major trauma in older people is particularly difficult, so we will also specifically focus on this age group. We will then take the best-performing tool and introduce it into practice in an area of each ambulance service, to see how it works in real life. To find out about the experiences and views of patients, and paramedics using the tool, we will carry out interviews and focus groups. We will also consult with major trauma specialists, service managers and other stakeholders to assess the possible impact of the tool.

We have talked to patients affected by serious injury, and a group of patients involved in research about emergency care, while developing these research ideas. Members of these groups have agreed to join an advisory panel to help guide any future study. We have included a lay person with personal experience of major trauma as part of our research team alongside specialists in emergency medicine, pre-hospital practice, and major trauma. We have also consulted national specialist groups and gained support from participating ambulance services.

What are the possible benefits and risks of participating?
Patients may be correctly identified as suffering a true major trauma by the use of the new tool (which could have a potential positive impact on their overall care), whereas under previous tools, they may not.
Equally, the new tool may fail to recognise true major trauma patients (which could have a potential negative impact on their overall care), when the previous used tool would have correctly identified them.

Where is the study run from?
The University of Sheffield’s Clinical Trials Research Unit (CTRU) is the leading centre.
The 4 Ambulance Services involved are:
Yorkshire Ambulance Service NHS Trust
West Midlands Ambulance Service NHS Trust
London Ambulance Service NHS Trust
South West Ambulance Service NHS Foundation Trust

When is the study starting and how long is it expected to run for?
From November 2018 to August 2022

Who is funding the study?
The study is funded by the National Institute of Health Research, Health Technology Assessment programme.

Who is the main contact?
Dr Sam Keating
Email: s.m.keating@sheffield.ac.uk

Study website

Contact information

Dr Samuel Keating
Public

Clinical Trials Research Unit
ScHARR
University of Sheffield
Room 2027
Regent Court
30 Regent Street
Sheffield
S1 4DA
United Kingdom

ORCID ID	0000-0003-3685-2849
Phone	0114 22 25156
Email	s.m.keating@sheffield.ac.uk

Study information

Eligibility

Locations

Countries of recruitment

• England
• United Kingdom

Study participating centres

Sponsor information

The University of Sheffield
University/education

Western Bank
Sheffield
S10 2TN
England
United Kingdom

Website	www.sheffield.ac.uk
"ROR"	https://ror.org/05krs5044

Funders

Funder type

Government

Results and Publications

Study outputs

Additional files

ISRCTN17968752_ PROTOCOL_v2_18Sep19.docx

Uploaded 13/02/2020

Editorial Notes

04/06/2024: Publication reference added.
18/04/2024: The intention to publish date has been changed from 01/12/2022 to 18/06/2024. Total final enrolment added.
21/06/2021: The following changes have been made:
1. The overall trial end date has been changed from 31/05/2021 to 31/08/2022 and the plain English summary has been updated to reflect this change.
2. The intention to publish date has been changed from 01/06/2021 to 01/12/2022.
13/02/2020: Uploaded protocol version 2 18/09/2019 (not peer-reviewed)
05/11/2019: The ethics approval was added.
25/01/2019: Internal review.