Effectiveness of a 2-Specialty, 2-Tiered Triage and Trauma Team Activation Protocol,☆☆,

Presented at the 26th Annual Scientific Meeting of the Western Trauma Association, Grand Targhee, WY, February 24–March 2, 1996.
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Abstract

Study Objective: To determine the effectiveness, safety, and resource allocation of a 2-specialty, 2-tiered triage and trauma team activation protocol. Methods: We conducted a 6-month retrospective analysis of a 2-specialty, 2-tiered trauma team activation system at an urban Level I trauma center. Based on prehospital data, patients with a high likelihood of serious injury were assigned to triage category 1 and patients with a low likelihood of serious injury were assigned to category 2. Category 1 patients were immediately evaluated by both emergency medicine and trauma services. Category 2 patients were evaluated initially by emergency medicine staff with a mandatory trauma service consultation. Main outcomes measured included mortality, need for emergency procedures, need for emergency surgery, complications, and discharge disposition. Potential physician-hours saved were calculated for category 2 cases. Results: Five hundred sixty-one patients were assigned a triage classification (272 to category I and 289 to category 2). Category 1 patients had a higher mortality rate (95% confidence interval [CI] for difference of 15.9%, 11.1% to 20.7%, P<.0001), need for emergency surgery (10.7% versus 1.4%, 95% CI for difference of 9.3%, 5.2% to 13.4%; P<.0001), need for emergency procedures (89% of total procedures, 95% CI 83% to 95%; P<.0001), and discharges to rehabilitation facilities (95% CI for difference of 15.1%, 9.3% to 21.0%; P<.0001). The 2-tiered response system saved an estimated 578 physician-hours of time for the trauma service over the study period. Conclusion: This evaluation tool effectively predicts likelihood of serious injury, mortality, need for emergency surgery, and need for rehabilitation. Patients with a low likelihood of serious injury may be initially evaluated by the emergency medicine service effectively and safely, thus allowing more efficient use of surgical personnel.[Plaisier BR, Meldon SW, Super DM, Jouriles NJ, Barnoski AL, Fallon WF Jr, Malagnoni MA: Effectiveness of a 2-specialty, 2-tiered triage and trauma team activation protocol. Ann Emerg Med October 1998;32:436-441.]

Section snippets

INTRODUCTION

Injuries constitute the greatest threat to life for individuals younger than 45 years of age. Each year approximately 70 million people suffer an injury and 140,000 die as the result of their injuries.1 Even though it is well established that outcome in severely injured patients is improved by rapid transport to a Level I trauma center, trauma centers often care for a large number of less seriously injured patients as well.2, 3, 4, 5 Therefore it is important that the resources of trauma

MATERIALS AND METHODS

We conducted a retrospective analysis of a 2-specialty, 2-tiered trauma team activation system over a 6-month period at our ACS-verified Level I adult trauma center with pediatric commitment, which serves a population in excess of 2 million people. Evaluation and resuscitation occurs jointly by the departments of surgery and emergency medicine. Patients are classified as either category 1 (high likelihood of serious injury) or category 2 (low likelihood of serious injury) using a triage

RESULTS

During the 6-month study period, 561 patients fulfilled criteria for categorization. Of these, 272 (48.5%) were classified as category 1 and 289 (51.5%) were in category 2. Demographic data are shown in Table 1.

. Patient characteristics for category I and category 2 groups.

CharacteristicCategory 1 (n=272) No. (%)Category 2 (n=289) No. (%)
Male186 (68%)201 (70%)
Mean age (y±SD)35.9±17.834.5±20.1
Penetrating injury63 (23%)3 (1%)*
* P <.0001.
The age and gender for the 2 groups were similar. Category 1

DISCUSSION

Trauma team activation is tied directly to prehospital triage. The ACS Committee on Trauma recommends that guidelines used to judge the seventy of injury and need for trauma center care must address the following: (1) abnormal physiologic signs, (2) obvious anatomic injury, (3) mechanism of injury, and (4) concurrent disease.2 Physiologic abnormalities were the first parameters chosen for field triage because they were most easily quantified. Although abnormal physiology is a very specific

References (22)

  • WB Long et al.

    Accuracy and relationship of mechanisms of injury, trauma score, and injury seventy score in identifying major trauma

    Am J Surg

    (1986)
  • FG Dekeyser et al.

    Decreasing the cost of trauma care: A system of secondary inhospital triage

    Ann Emerg Med

    (1994)
  • FH Foege et al.

    Injury in America: A Continuing Public Health Problem.

  • American College of Surgeons Committee on Trauma

    Resources for Optimal Care of the Injured Patient

    (1993)
  • JG West et al.

    Impact of regionalization: the Orange County experience

    Arch Surg

    (1983)
  • RH Cales et al.

    Preventable trauma deaths: A review of trauma care systems development

    JAMA

    (1985)
  • SR Shackford et al.

    Impact of a trauma system on outcome of severely injured patients

    Arch Surg

    (1987)
  • WW Hauck et al.

    A comparison of large-sample confidence interval methods for the difference of two binomial probabilities

    American Statistician

    (1986)
  • DJ Kreis et al.

    A prospective evaluation of field categorization of trauma patients

    J Trauma

    (1988)
  • JG West et al.

    A method for evaluating field triage criteria

    J Trauma

    (1986)
  • G Kane et al.

    Empirical development and evaluation of prehospital trauma triage instruments

    J Trauma

    (1985)
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    From the Departments of Surgery,* Emergency Medicine, and Pediatrics,§ Case Western Reserve University School of Medicine, MetroHealth Medical Center Campus, Cleveland, OH.

    ☆☆

    Reprint no. 47/1/92999

    Reprints not available from the authors.

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