Comparison of the 1999 and 2006 trauma triage guidelines

Where do patients go

E. Brooke Lerner, Manish N. Shah, Robert A. Swor, Jeremy T. Cushman, Clare E. Guse, Karen Brasel, Alan Blatt, Gregory Jurkovich

Research output: Contribution to journalArticle

30 Citations (Scopus)

Abstract

Background. In 2006, the Centers for Disease Control and Prevention (CDC) released a revised Field Triage Decision Scheme. It is unknown how this modified scheme will affect the number of patients identified by emergency medical services (EMS) for transport to a trauma center. Objectives. To determine the change in the number of patients transported by EMS who meet the 2006 scheme, compared with the 1999 scheme, and to determine how the scheme change would affect under- and overtriage rates. Methods. The EMS providers in charge of care for injured adult patients transported to a regional trauma center in three mid-sized cities were interviewed immediately after completing transport. All injured patients were included, regardless of severity. The interview included patient demographics, vital signs, apparent anatomic injury, and the mechanism of injury. Included patients were then followed through hospital discharge. The 1999 and 2006 scheme criteria were each retrospectively applied to the collected data. The numbers of patients identified by the two schemes were determined. Patients were considered to have needed a trauma center if they had nonorthopedic surgery within 24 hours, were admitted to an intensive care unit (ICU), or died. Data were analyzed using descriptive statistics including 95 confidence intervals. Results. EMS interviews were conducted for 11,892 patients and outcome data were unavailable for one patient. The average patient age was 48 years; 51% of the patients were men. Providers reported bringing 54% of the enrolled patients to the trauma center based on their local trauma protocol. Medical record review identified 12% of the enrolled patients as needing a trauma center. Use of the 2006 scheme would have resulted in 1,423 fewer patients (12%; 95% confidence interval [CI]:11%-13%) being identified as needing a trauma center by EMS providers (40%; 95% CI: 39%-41% versus 28%; 95% CI: 27%-29%). Of those patients, 1,344 (94%) did not actually need the resources of a trauma center, whereas 78 (6%) actually needed the resources of a trauma center and would have been undertriaged. Conclusion. Use of the 2006 Field Triage Decision Scheme would have resulted in a significant decrease in the number of patients identified as needing the resources of a trauma center. These changes reduced overtriage while causing a small increase in the number of patients who would have been undertriaged.

Original languageEnglish (US)
Pages (from-to)12-17
Number of pages6
JournalPrehospital Emergency Care
Volume15
Issue number1
DOIs
StatePublished - Jan 1 2010
Externally publishedYes

Fingerprint

Triage
Guidelines
Trauma Centers
Wounds and Injuries
Emergency Medical Services
Confidence Intervals
Interviews
Vital Signs
Centers for Disease Control and Prevention (U.S.)

Keywords

  • decision scheme
  • emergency medical services
  • emergency medical technicians
  • triage
  • wounds and injury

ASJC Scopus subject areas

  • Emergency Medicine
  • Emergency

Cite this

Comparison of the 1999 and 2006 trauma triage guidelines : Where do patients go. / Lerner, E. Brooke; Shah, Manish N.; Swor, Robert A.; Cushman, Jeremy T.; Guse, Clare E.; Brasel, Karen; Blatt, Alan; Jurkovich, Gregory.

In: Prehospital Emergency Care, Vol. 15, No. 1, 01.01.2010, p. 12-17.

Research output: Contribution to journalArticle

Lerner, EB, Shah, MN, Swor, RA, Cushman, JT, Guse, CE, Brasel, K, Blatt, A & Jurkovich, G 2010, 'Comparison of the 1999 and 2006 trauma triage guidelines: Where do patients go', Prehospital Emergency Care, vol. 15, no. 1, pp. 12-17. https://doi.org/10.3109/10903127.2010.519819
Lerner, E. Brooke ; Shah, Manish N. ; Swor, Robert A. ; Cushman, Jeremy T. ; Guse, Clare E. ; Brasel, Karen ; Blatt, Alan ; Jurkovich, Gregory. / Comparison of the 1999 and 2006 trauma triage guidelines : Where do patients go. In: Prehospital Emergency Care. 2010 ; Vol. 15, No. 1. pp. 12-17.
@article{3715e474c5d9431b8c1c774369411fa1,
title = "Comparison of the 1999 and 2006 trauma triage guidelines: Where do patients go",
abstract = "Background. In 2006, the Centers for Disease Control and Prevention (CDC) released a revised Field Triage Decision Scheme. It is unknown how this modified scheme will affect the number of patients identified by emergency medical services (EMS) for transport to a trauma center. Objectives. To determine the change in the number of patients transported by EMS who meet the 2006 scheme, compared with the 1999 scheme, and to determine how the scheme change would affect under- and overtriage rates. Methods. The EMS providers in charge of care for injured adult patients transported to a regional trauma center in three mid-sized cities were interviewed immediately after completing transport. All injured patients were included, regardless of severity. The interview included patient demographics, vital signs, apparent anatomic injury, and the mechanism of injury. Included patients were then followed through hospital discharge. The 1999 and 2006 scheme criteria were each retrospectively applied to the collected data. The numbers of patients identified by the two schemes were determined. Patients were considered to have needed a trauma center if they had nonorthopedic surgery within 24 hours, were admitted to an intensive care unit (ICU), or died. Data were analyzed using descriptive statistics including 95 confidence intervals. Results. EMS interviews were conducted for 11,892 patients and outcome data were unavailable for one patient. The average patient age was 48 years; 51{\%} of the patients were men. Providers reported bringing 54{\%} of the enrolled patients to the trauma center based on their local trauma protocol. Medical record review identified 12{\%} of the enrolled patients as needing a trauma center. Use of the 2006 scheme would have resulted in 1,423 fewer patients (12{\%}; 95{\%} confidence interval [CI]:11{\%}-13{\%}) being identified as needing a trauma center by EMS providers (40{\%}; 95{\%} CI: 39{\%}-41{\%} versus 28{\%}; 95{\%} CI: 27{\%}-29{\%}). Of those patients, 1,344 (94{\%}) did not actually need the resources of a trauma center, whereas 78 (6{\%}) actually needed the resources of a trauma center and would have been undertriaged. Conclusion. Use of the 2006 Field Triage Decision Scheme would have resulted in a significant decrease in the number of patients identified as needing the resources of a trauma center. These changes reduced overtriage while causing a small increase in the number of patients who would have been undertriaged.",
keywords = "decision scheme, emergency medical services, emergency medical technicians, triage, wounds and injury",
author = "Lerner, {E. Brooke} and Shah, {Manish N.} and Swor, {Robert A.} and Cushman, {Jeremy T.} and Guse, {Clare E.} and Karen Brasel and Alan Blatt and Gregory Jurkovich",
year = "2010",
month = "1",
day = "1",
doi = "10.3109/10903127.2010.519819",
language = "English (US)",
volume = "15",
pages = "12--17",
journal = "Prehospital Emergency Care",
issn = "1090-3127",
publisher = "Informa Healthcare",
number = "1",

}

TY - JOUR

T1 - Comparison of the 1999 and 2006 trauma triage guidelines

T2 - Where do patients go

AU - Lerner, E. Brooke

AU - Shah, Manish N.

AU - Swor, Robert A.

AU - Cushman, Jeremy T.

AU - Guse, Clare E.

AU - Brasel, Karen

AU - Blatt, Alan

AU - Jurkovich, Gregory

PY - 2010/1/1

Y1 - 2010/1/1

N2 - Background. In 2006, the Centers for Disease Control and Prevention (CDC) released a revised Field Triage Decision Scheme. It is unknown how this modified scheme will affect the number of patients identified by emergency medical services (EMS) for transport to a trauma center. Objectives. To determine the change in the number of patients transported by EMS who meet the 2006 scheme, compared with the 1999 scheme, and to determine how the scheme change would affect under- and overtriage rates. Methods. The EMS providers in charge of care for injured adult patients transported to a regional trauma center in three mid-sized cities were interviewed immediately after completing transport. All injured patients were included, regardless of severity. The interview included patient demographics, vital signs, apparent anatomic injury, and the mechanism of injury. Included patients were then followed through hospital discharge. The 1999 and 2006 scheme criteria were each retrospectively applied to the collected data. The numbers of patients identified by the two schemes were determined. Patients were considered to have needed a trauma center if they had nonorthopedic surgery within 24 hours, were admitted to an intensive care unit (ICU), or died. Data were analyzed using descriptive statistics including 95 confidence intervals. Results. EMS interviews were conducted for 11,892 patients and outcome data were unavailable for one patient. The average patient age was 48 years; 51% of the patients were men. Providers reported bringing 54% of the enrolled patients to the trauma center based on their local trauma protocol. Medical record review identified 12% of the enrolled patients as needing a trauma center. Use of the 2006 scheme would have resulted in 1,423 fewer patients (12%; 95% confidence interval [CI]:11%-13%) being identified as needing a trauma center by EMS providers (40%; 95% CI: 39%-41% versus 28%; 95% CI: 27%-29%). Of those patients, 1,344 (94%) did not actually need the resources of a trauma center, whereas 78 (6%) actually needed the resources of a trauma center and would have been undertriaged. Conclusion. Use of the 2006 Field Triage Decision Scheme would have resulted in a significant decrease in the number of patients identified as needing the resources of a trauma center. These changes reduced overtriage while causing a small increase in the number of patients who would have been undertriaged.

AB - Background. In 2006, the Centers for Disease Control and Prevention (CDC) released a revised Field Triage Decision Scheme. It is unknown how this modified scheme will affect the number of patients identified by emergency medical services (EMS) for transport to a trauma center. Objectives. To determine the change in the number of patients transported by EMS who meet the 2006 scheme, compared with the 1999 scheme, and to determine how the scheme change would affect under- and overtriage rates. Methods. The EMS providers in charge of care for injured adult patients transported to a regional trauma center in three mid-sized cities were interviewed immediately after completing transport. All injured patients were included, regardless of severity. The interview included patient demographics, vital signs, apparent anatomic injury, and the mechanism of injury. Included patients were then followed through hospital discharge. The 1999 and 2006 scheme criteria were each retrospectively applied to the collected data. The numbers of patients identified by the two schemes were determined. Patients were considered to have needed a trauma center if they had nonorthopedic surgery within 24 hours, were admitted to an intensive care unit (ICU), or died. Data were analyzed using descriptive statistics including 95 confidence intervals. Results. EMS interviews were conducted for 11,892 patients and outcome data were unavailable for one patient. The average patient age was 48 years; 51% of the patients were men. Providers reported bringing 54% of the enrolled patients to the trauma center based on their local trauma protocol. Medical record review identified 12% of the enrolled patients as needing a trauma center. Use of the 2006 scheme would have resulted in 1,423 fewer patients (12%; 95% confidence interval [CI]:11%-13%) being identified as needing a trauma center by EMS providers (40%; 95% CI: 39%-41% versus 28%; 95% CI: 27%-29%). Of those patients, 1,344 (94%) did not actually need the resources of a trauma center, whereas 78 (6%) actually needed the resources of a trauma center and would have been undertriaged. Conclusion. Use of the 2006 Field Triage Decision Scheme would have resulted in a significant decrease in the number of patients identified as needing the resources of a trauma center. These changes reduced overtriage while causing a small increase in the number of patients who would have been undertriaged.

KW - decision scheme

KW - emergency medical services

KW - emergency medical technicians

KW - triage

KW - wounds and injury

UR - http://www.scopus.com/inward/record.url?scp=78649518375&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=78649518375&partnerID=8YFLogxK

U2 - 10.3109/10903127.2010.519819

DO - 10.3109/10903127.2010.519819

M3 - Article

VL - 15

SP - 12

EP - 17

JO - Prehospital Emergency Care

JF - Prehospital Emergency Care

SN - 1090-3127

IS - 1

ER -