Evaluation of the Vittel Criteria for Pre-hospital Triage of Severe Trauma Patients in the French West Indies and in French Guiana

Trauma severity criteria and prehospital triage scores have been proposed since the 1990s. In 2002, a conference of experts in France proposed a decision algorithm for prehospital triage of trauma patients, known as the Vittel criteria. Indeed, the presence of a single criterion out of the 24 others should direct the patient to a trauma referral center (Level 1 Trauma Center). However, since their implementation, few studies have evaluated the relevance of these criteria on over- or under-triage, on the prescription of additional imaging tests, and finally on the prognosis of patients, including disabling sequelae. Indeed, some criteria are subjective and taken alone, it seems difficult to be able to put them on the same level to guide the patient.

In the French Antilles-Guiana inter-region, trauma from accidents on public roads and assaults with knives or firearms are a very common reason for interventions by SMUR teams. Despite this frequency, knowledge of the local epidemiology of these injuries is patchy. Furthermore, the referral of patients treated in pre-hospital care, either by firefighter teams or by the SMUR, is almost always done to the only reference health facility in each of the three French departments (Martinique, Guadeloupe, Guiana). The existence of only one trauma reference center per territory questions the relevance of using the Vittel criteria in the French Antilles-Guyana.

Twenty years after the development of the Vittel criteria, several changes have occurred in society, particularly in road safety and personal protective equipment. These advances would result in a reduction in the risks and severity related to accidents. Despite all these security advances, there is a lack of use and respect for them in the territories of the Antilles-Guiana. At the same time, violence and assaults by weapon have evolved with the use of firearms and weapons of war relatively frequently in our territories.

The relevance of the various Vittel criteria must be reassessed, particularly in the Antilles-Guyana where the typology of patients and the urban network is different from that of mainland France. The hypotheses are that certain criteria such as age, comorbidities, speed and deformation of vehicles, taken in isolation, would not be prognostic criteria for a serious anatomical injury or intensive care or even early mortality. Conversely, other criteria such as the taking of toxics or two-wheeled road accidents would be more important criteria to take into consideration.

Inclusion criteria

• Minor patients (2-17 years) and adults (≥ 18 years).
• Patients treated in the emergency units of the hospitals participating in the study, whether they were brought by a SAMU/SMUR team, by a rescue and victim assistance vehicle or arrived directly.
• Patients suspected of severe trauma, defined as trauma likely to have caused multiple injuries and/or threatening the vital or functional prognosis.
• Patient if he is able to, or representative of the patient in case of incapacity, having given his agreement for the use of his medical data for this research.

Exclusion criteria

• Absence of consent from the patient, or representative to the use of the data for the research.