Mechanism of injury does not predict acuity or level of service need: field triage criteria revisited☆
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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2010, SurgeryCitation Excerpt :This is because our group has previously published data on the impact of specific triage criteria and has determined that our triage criterion stratifies patients appropriately according to injury severity.11 Nevertheless, patients who meet traditional prehospital criteria for mechanism of injury are likely to be severely injured based upon ISS and mortality, and also to have a propensity to need urgent surgery and ICU care; Santaniello et al12 therefore suggested that it may be more practical to evaluate criteria in relation to their association with the need for such services. The identification of criteria that have a high yield for selecting resource-intensive patients might be more beneficial, especially for prehospital systems and in contrast to in-hospital trauma alert schemes.
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Presented at the 60th Annual Meeting of the Central Surgical Association, Toronto, Ontario, Canada, March 20-22, 2003.