A simplified trauma triage system safely reduces overtriage and improves provider satisfaction: a prospective study

Shawhan, Robert; McVay, Derek P.; Casey, Linda; Spears, Tara; Steele, Scott R.; Martin, Matthew J.

doi:10.1016/j.amjsurg.2015.01.008

Cited by 19 publications

(17 citation statements)

References 17 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Positive effects on mortality and triage rates after implementation of triage protocols or revision of existing criteria has also been demonstrated in other studies. 14,24,[75][76][77] Shawhan et al 16 showed in a study similar to ours, that over triage can be reduced and under triage kept at the same safe level after introducing a simplified triage system. However, there are other studies that have found that there was no change in over-and undertriage rates after criteria revisions.…”

Section: Resultssupporting

confidence: 80%

See 1 more Smart Citation

Patient experiences of initial trauma care

Granström

Strömmer²,

Falk

et al. 2019

International Emergency Nursing

View full text Add to dashboard Cite

Section: Resultssupporting

confidence: 80%

“…Monitoring 'over triage' and 'under triage' is often used as an indication of the trauma care quality. Various methods and algorithms on how to calculate over-and under triage are used in research, 7,[12][13][14][15][16] and therefore, it can be difficult to compare results from different trauma centres.…”

Section: Over Triage and Under Triagementioning

confidence: 99%

Patient experiences of initial trauma care

Granström

Strömmer²,

Falk

et al. 2019

International Emergency Nursing

View full text Add to dashboard Cite

“…39–41 Tominaga and colleagues developed a “trauma resource” designation that avoided trauma team activation, but included expedited evaluation in the ED for patients not meeting ACS activation criteria. 42 They reported no increase in mortality with a potential cost savings of nearly $1million.…”

Section: Discussionmentioning

confidence: 99%

Prehospital lactate improves accuracy of prehospital criteria for designating trauma activation level

Brown

Lerner

Sperry

et al. 2016

Journal of Trauma and Acute Care Surgery

View full text Add to dashboard Cite

Background Trauma activation level is determined by prehospital criteria. The American College of Surgeons (ACS) recommends trauma activation criteria; however, their accuracy may be limited. Prehospital lactate has shown promise in predicting trauma center resource requirements. Our objective was to investigate the added value of incorporating prehospital lactate in an algorithm to designate trauma activation level. Methods Air medical trauma patients undergoing prehospital lactate measurement were included. Algorithms using ACS activation criteria (ACS) and ACS activation criteria plus prehospital lactate (ACS+LAC) to designate trauma activation level were compared. Test characteristics and net reclassification improvement (NRI), which evaluates reclassification of patients among risk categories with additional predictive variables, were calculated. Algorithms were compared to predict trauma center need (TCN) defined as >1unit of blood in the ED; spinal cord injury; advanced airway; thoracotomy or pericardiocentesis; ICP monitoring; emergent operative or interventional radiology procedure; or death. Results There were 6,347 patients included. Twenty-eight percent had TCN. The ACS+LAC algorithm upgraded 256 patients and downgraded 548 patients compared to the ACS algorithm. The ACS+LAC algorithm versus ACS algorithm had a NRI of 0.058 (95%CI 0.044, 0.071; p<0.01), with an event NRI of −0.5% and non-event NRI of 6.2%. When weighted to favor changes in under-triage, the ACS+LAC still had a favorable overall reclassification (wNRI 0.041; 95%CI 0.028, 0.054; p=0.01). The ACS+LAC algorithm increased PPV, NPV, and accuracy. Over-triage was reduced 7.2%, while under-triage only increased 0.7%. The area under the curve (AUC) was significantly higher for the ACS+LAC algorithm (0.79 vs. 0.76, p<0.01). Conclusions The ACS+LAC algorithm reclassified patients to more appropriate levels of trauma activation when compared to the ACS algorithm. This overall benefit is achieved by significant reduction in over-triage relative to very small increase in under-triage. In the context of trauma team activation, this trade-off may be acceptable, especially in the current healthcare environment. Level of Evidence Diagnostic study, Level IV

show abstract

“…Uleberg et al found that high energy trauma per se did not justify trauma team activation in asymptomatic patients [ 33 ]. Totally omitting injury criteria from the ERTTAC list was shown to result in a decrease of overtriage by 22–35% with a simultaneous increase of undertriage by 1–3% [ 17 , 34 ]. Lerner et al reported that ERTTAC such as death of another passenger in the same vehicle, height of fall and pre-hospital rescue time best predicted the need for trauma centre resources [ 16 ].…”

Section: Discussionmentioning

confidence: 99%

Simple modification of trauma mechanism alarm criteria published for the TraumaNetwork DGU® may significantly improve overtriage – a cross sectional study

Braken

Amsler

Groß

2018

Scand J Trauma Resusc Emerg Med

View full text Add to dashboard Cite

BackgroundNo consensus exists in the literature on the use of uniform emergency room trauma team activation criteria (ERTTAC). Today excessive over- or undertriage rates continue to be a challenge for most trauma centres. Application of ERTTAC, published for use in the German TraumaNetwork DGU®, at a Swiss trauma centre resulted in a high overtriage rate. The aim of the investigation was to analyse the ERTTAC in detail with the intention of possible improvement.MethodsThe investigation included consecutive adult (age > 15 years) trauma patients treated at the emergency department of a level II trauma centre from 01.01.2013–31.12.2015. All data were collected prospectively. To identify over- and undertriage, patients with an Injury Severity Score (ISS) > 15 were defined as requiring specific emergency room (ER) management. ANOVA, Student’s t-test and chi-square analysis were used for statistical analysis with mean values ± standard deviation.Results1378 adult injured (64% male) received ER trauma team treatment (mean age 48.3 ± 21.2 years; ISS 9.7 ± 9.6) during the observation period. Of those, 326 ER patients (23.7%) were diagnosed with an ISS > 15, which proved to be an overtriage of 76.3%. 80/406 trauma patients with an ISS > 15 were not referred to the ER, resulting in an actual undertriage rate of 19.7%, mainly because the criteria list was not observed. Effectively applying ERTTAC according to the protocol in all cases would have reduced undertriage to 2.0% (8/406). The most frequent trigger for trauma team activation was injury mechanism (65%). A simulation revealed that omitting the criterion ‘passenger of car or truck’ (n = 326) would have prevented overtriage in 257 cases, as such lowering overtriage rate to 62.4% and at the same time increasing undertriage by only 8 cases to 7.1%.ConclusionApplication of ERTTAC as published for TraumaNetwork DGU® resulted in a lower undertriage but higher overtriage rate than recommended by the American College of Surgeons. Omitting the criterion ‘passenger of car or truck’ markedly improved overtriage with only a minimal increase in undertriage.Trial registrationNCT02165137; retrospectively registered 11. June 2014.

show abstract

A simplified trauma triage system safely reduces overtriage and improves provider satisfaction: a prospective study

Cited by 19 publications

References 17 publications

Patient experiences of initial trauma care

Patient experiences of initial trauma care

Prehospital lactate improves accuracy of prehospital criteria for designating trauma activation level

Simple modification of trauma mechanism alarm criteria published for the TraumaNetwork DGU® may significantly improve overtriage – a cross sectional study

Contact Info

Product

Resources

About