Elsevier

Surgery

Volume 134, Issue 4, October 2003, Pages 698-703
Surgery

Mechanism of injury does not predict acuity or level of service need: field triage criteria revisited

https://doi.org/10.1016/S0039-6060(03)00331-3Get rights and content

Abstract

Background

Trauma systems use specific criteria based on physiologic, anatomic, and mechanistic factors for field triage. The purpose of this study was to evaluate the emergency department disposition of patients not meeting mandatory criteria (ie, physiologic or anatomic factors) for triage to a trauma center and the potential for over- or undertriage.

Methods

This was a retrospective review of trauma admissions from July 1999 to June 2001, to a level I trauma center. Triage criteria were classified as physiologic factors (n = 300), anatomic factors (n = 115), or mechanistic factors (n = 414), according to the criteria of the American College of Surgeons Committee on Trauma. Physiologic and anatomic factors were combined and compared with mechanistic factors.

Results

There were 1253 admissions during the study period. Sixty-six percent (n = 830) met study inclusion criteria. Fifty percent (n = 413) were admitted to the intensive care unit or operating room. Approximately 50% of each group (physiologic/anatomic, 52%; mechanistic, 47%; P = .08) were admitted directly to the operating room or to the intensive care unit.

Conclusions

Patients not meeting mandatory criteria for transfer to a trauma center often have serious injuries that require a higher level of care. The inclusion of all or select mechanistic criteria for evaluation at a trauma center is appropriate to achieve an acceptable rate of clinical undertriage, as well as resource undertriage and its subsequent complications.

Section snippets

Methods

A retrospective review of all adult (>17 years of age) trauma patients admitted from July 1, 1999 to June 31, 2001 and evaluated by the trauma service at a level one TC was conducted. Transfers from other hospitals in addition to patients transported directly from the field were included. Reasons for triage to our institution were classified according to the American College of Surgeons' Committee on Trauma criteria as physiologic (P), anatomic (A), or mechanism of injury (M). These were

Results

During the study period, 1253 patients were evaluated. Of these, 423 (34%) were excluded from the study. The most common reason was lack of the emergency medical service report and documentation of field triage criteria. This left 830 (66%) comprising the study population. Of these, 300 (36%) had P criteria, 115 (14%) exhibited A criteria, and 414 (50%) had M criteria. For the entire study population, 324 (39%) had an ED disposition to the ICU; 43% of these had P, 10% had A, and 47% had M.

Discussion

This study shows mechanism of injury criteria to have an appreciable and noteworthy degree of undertriage from an injury severity and mortality perspective. Upwards of 10% had an ISS≥15, and the mean ISS in this group was 12. This is not dissimilar from the mean ISS of the P and A criteria groups, which was 13 and 15, respectively, and about the same as the mean ISS of 13.8 for the entire sample. In group II patients (ISS≥15), 35% had M criteria. Mortality for M criteria patients was 2.3%,

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Presented at the 60th Annual Meeting of the Central Surgical Association, Toronto, Ontario, Canada, March 20-22, 2003.

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