Assessing the feasibility of the American College of Surgeons' benchmarks for the triage of trauma patients.
ABSTRACT To test the feasibility of accomplishing the American College of Surgeons Committee on Trauma benchmarks of less than 5% undertriage (treatment of patients with moderate to severe injuries at nontrauma centers [NTCs]) and less than 50% overtriage (transfer of patients with minor injuries to trauma centers [TCs]) given current practice patterns by describing transfer patterns for patients taken initially to NTCs and estimating volume shifts and potential lives saved if full implementation were to occur.
Retrospective cohort study of adult trauma patients initially evaluated at NTCs in Pennsylvania (between April 1, 2001, and March 31, 2005). We used published estimates of mortality risk reduction associated with treatment at TCs.
Undertriage and overtriage rates, estimated patient volume shifts, and number of lives saved.
A total of 93,880 adult trauma patients were initially evaluated at NTCs in Pennsylvania between 2001 and 2005. Undertriage was 69%; overtriage was 53%. Achieving less than 5% undertriage would require the transfer of 18,945 patients per year, a 5-fold increase from current practice (3650 transfers per year). Given an absolute mortality risk reduction of 1.9% for patients with moderate to severe injuries treated at TCs, this change in practice would save 99 potential lives per year or would require 191 transfers per year to save 1 potential life.
Given current practice patterns, American College of Surgeons Committee on Trauma recommendations for the regionalization of trauma patients may not be feasible. To achieve 5% undertriage, TCs must increase their capacity 5-fold, physicians at NTCs must increase their capacity to discriminate between moderate to severe and other injuries, or the guidelines must be modified.
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ABSTRACT: Physician non-compliance with clinical practice guidelines remains a critical barrier to high quality care. Serious games (using gaming technology for serious purposes) have emerged as a method of studying physician decision making. However, little is known about their validity.PLoS ONE 08/2014; 9(8):e105445. DOI:10.1371/journal.pone.0105445 · 3.53 Impact Factor
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ABSTRACT: The detection of occult or unpredictable injuries in motor vehicle crashes (MVCs) is crucial in correctly triaging patients and thus reducing fatalities. The purpose of the study was to develop a metric that indicates the likelihood that an injury sustained in a MVC would require management at a Level I/II trauma center (TC) versus a non-trauma center (non-TC).Injury 12/2014; 57. DOI:10.1016/j.injury.2014.11.036 · 2.46 Impact Factor
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ABSTRACT: Background There is evidence that regionalized trauma care and appropriate triage of major trauma patients improve patient outcomes. However, the national rate of undertriage and diagnoses of undertriaged patients are unknown. Methods We used the 2010 Nationwide Emergency Department Sample (NEDS) to estimate the national rate of undertriage, identify the prevalent diagnoses, and conduct a simulation analysis of the capacity increase required for level I and II trauma centers to accommodate undertriaged patients. Undertriaged patients were those with major trauma, Injury Severity Score (ISS) ≥ 16, who received definitive care at nontrauma centers (NTC) or level III trauma centers. The rate of undertriage was calculated with those receiving definitive care at a NTC center or level III center as a fraction of all major trauma patients. Results The estimated number of major trauma patient discharges in 2010 was 232,448. Level of care was known for 197,702 major trauma discharges and 34.0% were undertriaged in emergency departments. Elderly patients were at a significantly higher risk of being undertriaged. Traumatic brain injury (TBI) was the most common diagnosis, 40.2 % of the undertriaged patient diagnoses. In order to accommodate all undertriaged patients, level I and II trauma centers nationally would have to increase their capacity by 51.5%. Conclusions We found that over 1/3 of U.S. ED major trauma patients were undertriaged and more than 40% of undertriaged diagnoses were TBIs. A significant capacity increase at Level I and II trauma centers to accommodate these patients appears not feasible.American Journal of Emergency Medicine 09/2014; 32(9). DOI:10.1016/j.ajem.2014.05.038 · 1.15 Impact Factor