BACKGROUND: Our current trauma triage system uses patient and scene variables within a 3-tiered trauma response system. Our purpose was to evaluate the accuracy of the current system and to identify the most reliable variables for trauma triage. METHODS: This was a retrospective review at a level II trauma center. Multivariate logistic regression was used to identify independent predictors of the need for any urgent emergency department procedure or operative intervention. The current triage system was analyzed and compared with a proposed simplified system. RESULTS: There were 1495 consecutive trauma admissions identified, the majority (88%) were blunt mechanism. Urgent emergency department interventions were required in 11%, and 4% required emergent surgery. Logistic regression demonstrated that prehospital Glasgow Coma Score <14 (odds ratio [OR] 9.7), hypotension (OR 3.3), altered respiratory effort (OR 4.6), and penetrating truncal injury (OR 10.8) independently predicted the need for urgent intervention (all P < .01). The current system undertriaged only 1% but overtriaged 51% of patients. A simplified triage system using these 4 variables significantly decreased overtriage and reliably identified patients with severe injury. CONCLUSIONS: A simplified triage system using only highly predictive variables can safely decrease the high rate of overtriage of trauma patients.
BACKGROUND: Our current trauma triage system uses patient and scene variables within a 3-tiered trauma response system. Our purpose was to evaluate the accuracy of the current system and to identify the most reliable variables for trauma triage. METHODS: This was a retrospective review at a level II trauma center. Multivariate logistic regression was used to identify independent predictors of the need for any urgent emergency department procedure or operative intervention. The current triage system was analyzed and compared with a proposed simplified system. RESULTS: There were 1495 consecutive trauma admissions identified, the majority (88%) were blunt mechanism. Urgent emergency department interventions were required in 11%, and 4% required emergent surgery. Logistic regression demonstrated that prehospital Glasgow Coma Score <14 (odds ratio [OR] 9.7), hypotension (OR 3.3), altered respiratory effort (OR 4.6), and penetrating truncal injury (OR 10.8) independently predicted the need for urgent intervention (all P < .01). The current system undertriaged only 1% but overtriaged 51% of patients. A simplified triage system using these 4 variables significantly decreased overtriage and reliably identified patients with severe injury. CONCLUSIONS: A simplified triage system using only highly predictive variables can safely decrease the high rate of overtriage of traumapatients.
Authors: Christian Waydhas; Markus Baake; Lars Becker; Boris Buck; Helena Düsing; Björn Heindl; Kai Oliver Jensen; Rolf Lefering; Carsten Mand; T Paffrath; Uwe Schweigkofler; Kai Sprengel; Heiko Trentzsch; Bernd Wohlrath; Dan Bieler Journal: World J Surg Date: 2018-09 Impact factor: 3.352
Authors: Dowin H Boatright; Richard L Byyny; Emily Hopkins; Katherine Bakes; Jennifer Hissett; Java Tunson; Joshua S Easter; Comilla Sasson; Jody A Vogel; Denis Bensard; Jason S Haukoos Journal: J Am Coll Surg Date: 2013-04-23 Impact factor: 6.113
Authors: Michelle Scerbo; Hari Radhakrishnan; Bryan Cotton; Anahita Dua; Deborah Del Junco; Charles Wade; John B Holcomb Journal: J Surg Res Date: 2013-07-13 Impact factor: 2.192
Authors: Joshua B Brown; E Brooke Lerner; Jason L Sperry; Timothy R Billiar; Andrew B Peitzman; Francis X Guyette Journal: J Trauma Acute Care Surg Date: 2016-09 Impact factor: 3.313
Authors: Marius Rehn; Torsten Eken; Andreas Jorstad Krüger; Petter Andreas Steen; Nils Oddvar Skaga; Hans Morten Lossius Journal: Scand J Trauma Resusc Emerg Med Date: 2009-01-09 Impact factor: 2.953