Use of windscreen bullseye in a trauma triage tool.

Abstract

Background: Decision-making tools are used by prehospital services to triage trauma patients. Specific criteria aim to identify patients appropriate for direct transfer to a major trauma centre (MTC). In London, a novel criterion mandates MTC transfer for any pedestrian struck by a vehicle with a resultant windscreen impact or 'bullseye'.1 The use of this sign in triage has not been evaluated. Objective(s): To determine the efficacy of a windscreen bullseye in predicting requirement for specialist neurotrauma services. Method(s): A retrospective analysis was conducted of all adult trauma patients at a single MTC over a one-month period. Data was obtained from scanned paramedic notes and inpatient discharge summaries. The primary endpoint was defined as death in hospital, emergency surgery or admission to a neurotrauma unit. Result(s): Of 204 major trauma patients, 39 were a pedestrian struck by a vehicle. 17 of these patients had normal physiological parameters, and were triaged to an MTC only because of a windscreen bullseye. Out of these 17 patients, 6 had radiological evidence of traumatic brain injury (TBI) and required neurotrauma admission in intensive care or a high-dependency unit. Conclusion(s): The windscreen bullseye criterion was responsible for 6 patients with TBI to reach prompt and appropriate neurotrauma care. This group had normal pre-hospital vital signs and conscious state, and would otherwise not have been identified by the decision tool for direct MTC transfer. The bullseye criterion may be useful in triage to identify patients at high risk of TBI despite having normal physiological values.