RETRACTED: Development of Trauma Level Prediction Models Using Emergency Medical Service Vital Signs to Reduce Over- and Undertriage Rates in Penetrating Wounds and Falls of the Elderly

Abstract

Determining triage activation levels in geriatric patients who fall (GF), and patients with penetrating wounds can be difficult and inaccurate, resulting in excessive overtriage (OT) and undertriage (UT) rates. We developed trauma activation prediction models using field data to predict with greater accuracy trauma activation level and triage rates consistent with the ACS recommendations. Using data from the 2014 National Trauma Data Bank, we created binary regression equations for each type of injury (GF and penetrating wounds). The 2014 data were randomized and divided into two halves. The first half for each injury type was used to generate prediction models, whereas the second half of the 2014 data were combined with 2013 and 2015 National Trauma Data Bank data for model verification. Binary regression equations were generated from vital signs collected by EMS. A Cribari grid with ISS ≥ 15 was used to determine the appropriateness of activation level. Chi-square analysis was used to determine significant differences between OT, UT, and accuracy predictions. Using our triage models, we were able to obtain UTrates of less than 4 per cent for GF with OT rates of less than 40 per cent, UT rates less than 4.1 per cent and OT of less than 50 per cent for patients with gunshot wounds, and UTrates less than 4 per cent and OT rates less than 25 per cent for patients who had stab wounds. Our developed trauma level prediction models enable health providers to predict trauma activation levels that can result in OT and UT rates in the recommended ranges by the ACS.

Evaluation of elderly specific pre-hospital trauma triage criteria: a systematic review

“…All studies were observational and retrospective in design utilising data from established trauma databases, except for one which used a consensus panel of experts to develop elderly triage criteria [ 32 ]. The majority of studies (n = 8) retrospectively applied triage criteria to test triage criteria efficacy [ 23 , 25 – 30 , 33 ]. Two studies tested real-world application of triage criteria using a before and after design with retrospective analysis of efficacy [ 24 , 31 ].…”

“…before and after study. 3 years before Ohio Geriatric Trauma Triage Criteria adoption and 3 years after > 70 years Cull et al [ 25 ] Observational, retrospective USA Criteria derived and applied to database National Trauma Data Bank Yes. Binary regression equations ≥ 65 years Ichwan et al [ 26 ] Observational, retrospective USA Criteria applied to database Ohio trauma registry No.…”

“…Three studies utilised the Ohio Trauma Registry [ 24 , 26 , 33 ], two accessed data from the National Trauma Data Bank [ 23 , 25 ], and one used the National Automotive Sampling Crashworthiness System Database [ 31 ]. A further four studies [ 27 – 30 ] used local state or system-wide databases and with the exception of one [ 32 ], all studies were multi-centred.…”

“…Study inclusion and exclusion criteria varied, but typically included patients with traumatic injury transported by Emergency Medical Services (EMS) to hospital [ 24 , 26 – 31 ], excluding inter-hospital transfers [ 23 , 28 – 30 ], isolated hip fractures [ 24 , 26 , 33 ], and death before hospital arrival [ 23 , 28 , 29 ]. Two studies received grants from the Ohio Department of Public Safety [ 24 , 26 ], two from the Robert Wood Johnson Foundation [ 28 , 29 ], one from the Centre for Disease Control [ 30 ], one from the Agency for Healthcare Research and Quality [ 27 ], and one from local university funding [ 25 ]. Three studies did not report a funding source [ 31 – 33 ] and one study stated it did not receive any funding [ 23 ].…”

The impact of delayed time to first CT head in traumatic brain injury

“…The rate of undertriage, or identification of highrisk, severely injured patients not identified by TTA criteria, is carefully monitored. This is used as a variable in developing center-specific modifications, such as the addition of geriatric age [4][5][6], to the criteria set forth by the ACS COT.…”