Citation

Brooke Lerner E, Shah MN, Swor RA, Cushman JT, Guse CE, Brasel KJ, Blatt A, Jurkovich GJ. Prehosp. Emerg. Care 2011; 15(1): 12-17.

Affiliation

Department of Emergency Medicine (EBL); Department of Family and Community Medicine (CEG); Department of Surgery(KB), Medical College of Wisconsin, Milwaukee, Wisconsin; Department of Emergency Medicine (MNS, JTC), the University of Rochester, Rochester, New York; Department of Emergency Medicine (RAS), Oakland University/Beaumont Hospital School of Medicine; Royal Oak, Michigan; CUBRC (AB), Buffalo, New York; and Department of Surgery(GJJ), University of Washington, Harborview Medical Center, Seattle, Washington.

Copyright

(Copyright © 2011, National Association of EMS Physicians, Publisher Informa - Taylor and Francis Group)

DOI

10.3109/10903127.2010.519819

PMID

21054176

PMCID

PMC3058558

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. Key words: wounds and injury; triage; emergency medical services; emergency medical technicians; decision scheme.

Language: en