ResearchEffectiveness of prehospital trauma triage guidelines for the identification of major trauma in elderly motor vehicle crash victims*,**,★
Section snippets
Prehospital trauma triage
The clinical effectiveness of any trauma triage process lies in its ability to differentiate persons who have and have not sustained major trauma. Thus, when we think in terms of clinical effectiveness, we are actually referring to the validity, or accuracy, of the process, expressed as sensitivity and specificity. In epidemiologic terms,8 sensitivity is the probability of a positive test when disease is present, whereas specificity is the probability of a negative test when the disease is
Methods
This retrospective database study used information from the New Jersey Department of Health and Senior Services UB-92 Patient Discharge Data for 2000, the most recent year for which data were available. This statewide database includes multiple data elements for all persons discharged from acute care hospitals in any specified year.
Sample
The final sample included 2063 male and female MVC victims whose ages ranged from 25 to 97 years. Group 1, men and women ages 25 to 64 years, included 1600 persons (77.6%). Group 2, men and women ages 65 to 97 years, included 463 persons (22.4%). Additional demographic information regarding the sample is presented in Table 3.Group Gender No. (%) Age range (y) Mean age (y) Age SD ISS range Mean ISS ISS SD Group 1 (ages 25-64 y) Male 980 (47.50) 25-64 40.58
Discussion
The goal of trauma triage is rapid differentiation of major and minor trauma victims and transportation to the appropriate level of care. Trauma triage guidelines were developed by states to facilitate such differentiation. Although there is no widely held standard for acceptable degrees of undertriage and overtriage, Phillips et al3 recommended that undertriage not exceed 5% and overtriage not exceed 20%. Comparison of undertriage rates in this study to Phillips' recommendation indicates that
Recommendations for future research
This study did not intend to identify the causes of undertriage and overtriage or methods to prevent it from occurring. Moreover, further research is warranted to examine the sensitivity and specificity of the prehospital trauma triage guidelines throughout the entire state with a focus on age, gender differences, and the influence of selected preexisting diseases, particularly among older adults. Studies to examine “what went wrong” when under- and overtriage occur are also needed.
Moreover,
Limitations
The study sample was drawn from MVC victims who were admitted to acute care hospitals for treatment of their injuries. Excluded from the study were persons who died at the scene, en route to the hospital, or in the emergency department, as well as persons who were treated and released from the emergency department.
Implications for practice
Prehospital trauma triage guidelines have the potential to reduce preventable deaths, disability, and health care costs. In 1999 the ACS-COT11 recommended that age, as well as the existence of selected pre-existing diseases, be considered during prehospital triage of trauma victims. In light of the findings from this study and the 1999 ACS-COT recommendations, New Jersey and other states with similar guidelines should strongly consider adopting all of the Committee's prehospital triage
Acknowledgements
I acknowledge the valued contributions of Joanne Stevenson, RN, PhD, FAAN, professor emeritus, Rutgers University, who critiqued the proposal during the development process and edited the manuscript, and Howard Bondell, MS, PhD(c), Rutgers University, Department of Statistics, who performed the statistical analyses and assisted with manuscript editing.
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Cited by (66)
Modified physiologic criteria for the field triage scheme: Efficacy of major trauma recognition in different age groups in Asia
2024, American Journal of Emergency MedicineIntegrating transportation data with emergency medical service records to improve triage decision of high-risk trauma patients
2021, Journal of Transport and HealthCitation Excerpt :These represent the latest development on rule-based guidelines for field triage. Several studies were also conducted focusing on validating these guidelines (Miller et al., 2017; Scheetz, 2003). Apart from these guidelines, data mining and decision tree methods, such as Classification and Regression Tree (CART) (Scheetz et al., 2007; Newgard, 2016) and gradient boosting decision tree (van der Sluijs et al., 2019), were also largely used by researchers to predict the trauma triage decisions.
Effectiveness of prehospital trauma triage systems in selecting severely injured patients: Is comparative analysis possible?
2018, American Journal of Emergency MedicineImpact of triage guidelines on prehospital triage: comparison of guidelines with a statistical model
2017, Journal of Surgical ResearchGeriatric-specific triage criteria are more sensitive than standard adult criteria in identifying need for trauma center care in injured older adults
2015, Annals of Emergency MedicineCitation Excerpt :Despite this, current trauma systems undertriage geriatric patients, resulting in their being less likely to receive appropriate trauma center care.19-21,37,38,41-43 A key contributor to the undertriage problem is inadequacies in standard field triage criteria as applied to geriatric patients.19,26,41-43 For example, Nakamura et al19 recently reported that undertriage increases with advancing age.
Ambulance transport rates after motor vehicle collision for older vs. younger adults: A population-based study
2014, Accident Analysis and Prevention
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Funding for this study was provided by a combined grant from the Emergency Nurses Association Foundation and Sigma Theta Tau International and grants from the Rutgers University College of Nursing, Office of Research and Grants, and the Rutgers University College of Nursing Faculty Development Award Program.
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For reprints, write: Linda J. Scheetz, EdD, APRN, BC, CEN, Assistant Professor, College of Nursing, Rutgers, The State University of NJ, 180 University Ave, Newark, NJ 07102-1897; E-mail: [email protected] .
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J Emerg Nurs 2003;29:109-15.