OBJECTIVE: To apply a triage tool to patients on their arrival in the emergency department and determine the efficacy and safety of a two-tier trauma response. DESIGN: Descriptive prospective audit. SETTING: Principal urban referral hospital that provides a major trauma service. MATERIALS AND METHODS: The triage tool designated a major trauma or stable trauma response. A major trauma designation mobilised a multidisciplinary team and a stable trauma designation an expedited evaluation by emergency department staff. Chi-square test and Mann-Whitney U test were used to compare major and stable trauma designations. Triage accuracy was evaluated using outcome variables. MAIN RESULTS: 78% of 58 major trauma responses and 30% of 180 stable trauma responses were admitted. The median injury severity score (and interquartile range) of admitted patients was 9.0 (5.0-19.5) for major responses and 5.0 (2.0-9.0) for stable responses. The triage tool had a sensitivity of 65%, specificity of 87%, accuracy (appropriate triage rate) of 82%, undertriage rate of 8% and overtriage rate of 10%. CONCLUSION: The triage tool adequately distinguished between patients with and without major trauma. Undertriaged patients had timely and appropriate referral for definitive surgical care and had no adverse outcomes.
OBJECTIVE: To apply a triage tool to patients on their arrival in the emergency department and determine the efficacy and safety of a two-tier trauma response. DESIGN: Descriptive prospective audit. SETTING: Principal urban referral hospital that provides a major trauma service. MATERIALS AND METHODS: The triage tool designated a major trauma or stable trauma response. A major trauma designation mobilised a multidisciplinary team and a stable trauma designation an expedited evaluation by emergency department staff. Chi-square test and Mann-Whitney U test were used to compare major and stable trauma designations. Triage accuracy was evaluated using outcome variables. MAIN RESULTS: 78% of 58 major trauma responses and 30% of 180 stable trauma responses were admitted. The median injury severity score (and interquartile range) of admitted patients was 9.0 (5.0-19.5) for major responses and 5.0 (2.0-9.0) for stable responses. The triage tool had a sensitivity of 65%, specificity of 87%, accuracy (appropriate triage rate) of 82%, undertriage rate of 8% and overtriage rate of 10%. CONCLUSION: The triage tool adequately distinguished between patients with and without major trauma. Undertriaged patients had timely and appropriate referral for definitive surgical care and had no adverse outcomes.
Authors: E Brooke Lerner; Amy L Drendel; Richard A Falcone; Keith C Weitze; Mohamed K Badawy; Arthur Cooper; Jeremy T Cushman; Patrick C Drayna; David M Gourlay; Matthew P Gray; Manish I Shah; Manish N Shah Journal: J Trauma Acute Care Surg Date: 2015-03 Impact factor: 3.313