Increased mortality with undertriaged patients in a mature trauma center with an aggressive trauma team activation system
Purpose The American College of Surgeons Committee on Trauma (ACS-COT) has determined that a 5 % pre-hospital undertriage [UT; defined as Injury Severity Score (ISS) > 15 and not sent to a trauma center] is an acceptable rate for pre-hospital transfer to a non-trauma center. We sought to determin...
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| Veröffentlicht in: | European journal of trauma and emergency surgery (Munich : 2007) 2013-12, Vol.39 (6), p.599-603 |
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| container_title | European journal of trauma and emergency surgery (Munich : 2007) |
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| creator | Rogers, A. Rogers, F. B. Schwab, C. W. Bradburn, E. Lee, J. Wu, D. Miller, J. A. |
| description | Purpose
The American College of Surgeons Committee on Trauma (ACS-COT) has determined that a 5 % pre-hospital undertriage [UT; defined as Injury Severity Score (ISS) > 15 and not sent to a trauma center] is an acceptable rate for pre-hospital transfer to a non-trauma center. We sought to determine if this level of undertriage is acceptable within a mature Level II trauma center as a measure of the adequacy of its trauma activation system.
Methods
Our trauma activation system encompasses anatomic, physiologic, and mechanism of injury criteria. We defined UT as ISS > 15 and no trauma activation. All UT patients during the period 2000–2010 were compared to properly triaged patients (CT). The variables examined were mortality, emergency department (ED) length of stay (LOS), hospital LOS, complications, Coumadin use, and age >64 years.
Results
There were 18,324 patients admitted, with 1,156 (6.3 %) UT. UT is associated with an increase in mortality [odds ratio (OR) 3.0; 95 % confidence interval (CI) 2.4–3.8;
p
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| doi_str_mv | 10.1007/s00068-013-0289-z |
| format | Article |
| fullrecord | <record><control><sourceid>proquest_cross</sourceid><recordid>TN_cdi_proquest_miscellaneous_1761460537</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><sourcerecordid>1761460537</sourcerecordid><originalsourceid>FETCH-LOGICAL-c344t-b78743b5b6260d3454e8ce75a576e1ecd42212a4da86471361e712c6773bc1413</originalsourceid><addsrcrecordid>eNp9kMtO5DAQRS00I17DB7BBXs4m4LIdO70cIR4tIc0G1lbFKRq3OkmP7YCar8co0MtZuaR77pV8GDsHcQlC2KskhDBNJUBVQjaL6v2AHUNjVLVYaPixv5U6YicprQssTC0P2ZE0DdS1Vsdstxx8JEzU8X6MGTch7_hbyC98GjqKOQZclWyLOdCQEw8DR95jniLxHHHqkfsSUJxLWOLVKlJK4XUPZMKeo8_htayMA0-7lKn_xX4-4ybR2dd7yp5ubx6v76uHv3fL6z8PlVda56q1jdWqrVsjjeiUrjU1nmyNtTUE5DstJUjUHTZGW1AGyIL0xlrVetCgTtnveXcbx38Tpez6kDxtNjjQOCUH1oA2ola2oDCjPo4pRXp22xh6jDsHwn0ad7NxV4y7T-PuvXQuvuantqdu3_hWXAA5A6lEw4qiW49THMqX_7P6AV59jhw</addsrcrecordid><sourcetype>Aggregation Database</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>1761460537</pqid></control><display><type>article</type><title>Increased mortality with undertriaged patients in a mature trauma center with an aggressive trauma team activation system</title><source>SpringerLink Journals - AutoHoldings</source><creator>Rogers, A. ; Rogers, F. B. ; Schwab, C. W. ; Bradburn, E. ; Lee, J. ; Wu, D. ; Miller, J. A.</creator><creatorcontrib>Rogers, A. ; Rogers, F. B. ; Schwab, C. W. ; Bradburn, E. ; Lee, J. ; Wu, D. ; Miller, J. A.</creatorcontrib><description><![CDATA[Purpose
The American College of Surgeons Committee on Trauma (ACS-COT) has determined that a 5 % pre-hospital undertriage [UT; defined as Injury Severity Score (ISS) > 15 and not sent to a trauma center] is an acceptable rate for pre-hospital transfer to a non-trauma center. We sought to determine if this level of undertriage is acceptable within a mature Level II trauma center as a measure of the adequacy of its trauma activation system.
Methods
Our trauma activation system encompasses anatomic, physiologic, and mechanism of injury criteria. We defined UT as ISS > 15 and no trauma activation. All UT patients during the period 2000–2010 were compared to properly triaged patients (CT). The variables examined were mortality, emergency department (ED) length of stay (LOS), hospital LOS, complications, Coumadin use, and age >64 years.
Results
There were 18,324 patients admitted, with 1,156 (6.3 %) UT. UT is associated with an increase in mortality [odds ratio (OR) 3.0; 95 % confidence interval (CI) 2.4–3.8;
p
< 0.001), longer ED LOS (OR 54.5; 95 % CI 45.5–63.5;
p
< 0.001), and longer hospital LOS (OR 1.7; 95 % CI 1.4–2.1;
p
< 0.001). In addition, UT patients had a two-fold increase in complications (OR 2.0; 95 % CI 1.6–2.5;
p
< 0.001). When controlling for age ≥65 years, Revised Trauma Score (RTS) > 7.0, and one or more co-morbidities, UT patients had 2.18 times higher odds of mortality than their CT counterparts (OR 2.18; 95 % CI 1.57–3.01;
p
< 0.001). Patients on pre-hospital Coumadin (OR 3.61; 95 % CI 3.04–4.30;
p
< 0.001) and age >64 years (OR 4.93; 95 % CI 4.36–5.58;
p
< 0.001) were significant predictors of being undertriaged. A
p
-value ≤ 0.05 was considered to be significant.
Conclusions
Standard trauma activation criteria may not be adequate to identify the at-risk severely injured trauma patient. Further refinement of in-house trauma triage protocols is necessary if trauma centers are to improve outcomes following trauma.]]></description><identifier>ISSN: 1863-9933</identifier><identifier>EISSN: 1863-9941</identifier><identifier>DOI: 10.1007/s00068-013-0289-z</identifier><identifier>PMID: 26815543</identifier><language>eng</language><publisher>Berlin/Heidelberg: Springer Berlin Heidelberg</publisher><subject>Critical Care Medicine ; Emergency Medicine ; Intensive ; Medicine ; Medicine & Public Health ; Original Article ; Sports Medicine ; Surgery ; Surgical Orthopedics ; Traumatic Surgery</subject><ispartof>European journal of trauma and emergency surgery (Munich : 2007), 2013-12, Vol.39 (6), p.599-603</ispartof><rights>Springer-Verlag Berlin Heidelberg 2013</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c344t-b78743b5b6260d3454e8ce75a576e1ecd42212a4da86471361e712c6773bc1413</citedby><cites>FETCH-LOGICAL-c344t-b78743b5b6260d3454e8ce75a576e1ecd42212a4da86471361e712c6773bc1413</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://link.springer.com/content/pdf/10.1007/s00068-013-0289-z$$EPDF$$P50$$Gspringer$$H</linktopdf><linktohtml>$$Uhttps://link.springer.com/10.1007/s00068-013-0289-z$$EHTML$$P50$$Gspringer$$H</linktohtml><link.rule.ids>314,780,784,27924,27925,41488,42557,51319</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/26815543$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Rogers, A.</creatorcontrib><creatorcontrib>Rogers, F. B.</creatorcontrib><creatorcontrib>Schwab, C. W.</creatorcontrib><creatorcontrib>Bradburn, E.</creatorcontrib><creatorcontrib>Lee, J.</creatorcontrib><creatorcontrib>Wu, D.</creatorcontrib><creatorcontrib>Miller, J. A.</creatorcontrib><title>Increased mortality with undertriaged patients in a mature trauma center with an aggressive trauma team activation system</title><title>European journal of trauma and emergency surgery (Munich : 2007)</title><addtitle>Eur J Trauma Emerg Surg</addtitle><addtitle>Eur J Trauma Emerg Surg</addtitle><description><![CDATA[Purpose
The American College of Surgeons Committee on Trauma (ACS-COT) has determined that a 5 % pre-hospital undertriage [UT; defined as Injury Severity Score (ISS) > 15 and not sent to a trauma center] is an acceptable rate for pre-hospital transfer to a non-trauma center. We sought to determine if this level of undertriage is acceptable within a mature Level II trauma center as a measure of the adequacy of its trauma activation system.
Methods
Our trauma activation system encompasses anatomic, physiologic, and mechanism of injury criteria. We defined UT as ISS > 15 and no trauma activation. All UT patients during the period 2000–2010 were compared to properly triaged patients (CT). The variables examined were mortality, emergency department (ED) length of stay (LOS), hospital LOS, complications, Coumadin use, and age >64 years.
Results
There were 18,324 patients admitted, with 1,156 (6.3 %) UT. UT is associated with an increase in mortality [odds ratio (OR) 3.0; 95 % confidence interval (CI) 2.4–3.8;
p
< 0.001), longer ED LOS (OR 54.5; 95 % CI 45.5–63.5;
p
< 0.001), and longer hospital LOS (OR 1.7; 95 % CI 1.4–2.1;
p
< 0.001). In addition, UT patients had a two-fold increase in complications (OR 2.0; 95 % CI 1.6–2.5;
p
< 0.001). When controlling for age ≥65 years, Revised Trauma Score (RTS) > 7.0, and one or more co-morbidities, UT patients had 2.18 times higher odds of mortality than their CT counterparts (OR 2.18; 95 % CI 1.57–3.01;
p
< 0.001). Patients on pre-hospital Coumadin (OR 3.61; 95 % CI 3.04–4.30;
p
< 0.001) and age >64 years (OR 4.93; 95 % CI 4.36–5.58;
p
< 0.001) were significant predictors of being undertriaged. A
p
-value ≤ 0.05 was considered to be significant.
Conclusions
Standard trauma activation criteria may not be adequate to identify the at-risk severely injured trauma patient. Further refinement of in-house trauma triage protocols is necessary if trauma centers are to improve outcomes following trauma.]]></description><subject>Critical Care Medicine</subject><subject>Emergency Medicine</subject><subject>Intensive</subject><subject>Medicine</subject><subject>Medicine & Public Health</subject><subject>Original Article</subject><subject>Sports Medicine</subject><subject>Surgery</subject><subject>Surgical Orthopedics</subject><subject>Traumatic Surgery</subject><issn>1863-9933</issn><issn>1863-9941</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2013</creationdate><recordtype>article</recordtype><recordid>eNp9kMtO5DAQRS00I17DB7BBXs4m4LIdO70cIR4tIc0G1lbFKRq3OkmP7YCar8co0MtZuaR77pV8GDsHcQlC2KskhDBNJUBVQjaL6v2AHUNjVLVYaPixv5U6YicprQssTC0P2ZE0DdS1Vsdstxx8JEzU8X6MGTch7_hbyC98GjqKOQZclWyLOdCQEw8DR95jniLxHHHqkfsSUJxLWOLVKlJK4XUPZMKeo8_htayMA0-7lKn_xX4-4ybR2dd7yp5ubx6v76uHv3fL6z8PlVda56q1jdWqrVsjjeiUrjU1nmyNtTUE5DstJUjUHTZGW1AGyIL0xlrVetCgTtnveXcbx38Tpez6kDxtNjjQOCUH1oA2ola2oDCjPo4pRXp22xh6jDsHwn0ad7NxV4y7T-PuvXQuvuantqdu3_hWXAA5A6lEw4qiW49THMqX_7P6AV59jhw</recordid><startdate>20131201</startdate><enddate>20131201</enddate><creator>Rogers, A.</creator><creator>Rogers, F. B.</creator><creator>Schwab, C. W.</creator><creator>Bradburn, E.</creator><creator>Lee, J.</creator><creator>Wu, D.</creator><creator>Miller, J. A.</creator><general>Springer Berlin Heidelberg</general><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope></search><sort><creationdate>20131201</creationdate><title>Increased mortality with undertriaged patients in a mature trauma center with an aggressive trauma team activation system</title><author>Rogers, A. ; Rogers, F. B. ; Schwab, C. W. ; Bradburn, E. ; Lee, J. ; Wu, D. ; Miller, J. A.</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c344t-b78743b5b6260d3454e8ce75a576e1ecd42212a4da86471361e712c6773bc1413</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2013</creationdate><topic>Critical Care Medicine</topic><topic>Emergency Medicine</topic><topic>Intensive</topic><topic>Medicine</topic><topic>Medicine & Public Health</topic><topic>Original Article</topic><topic>Sports Medicine</topic><topic>Surgery</topic><topic>Surgical Orthopedics</topic><topic>Traumatic Surgery</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Rogers, A.</creatorcontrib><creatorcontrib>Rogers, F. B.</creatorcontrib><creatorcontrib>Schwab, C. W.</creatorcontrib><creatorcontrib>Bradburn, E.</creatorcontrib><creatorcontrib>Lee, J.</creatorcontrib><creatorcontrib>Wu, D.</creatorcontrib><creatorcontrib>Miller, J. A.</creatorcontrib><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>European journal of trauma and emergency surgery (Munich : 2007)</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Rogers, A.</au><au>Rogers, F. B.</au><au>Schwab, C. W.</au><au>Bradburn, E.</au><au>Lee, J.</au><au>Wu, D.</au><au>Miller, J. A.</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Increased mortality with undertriaged patients in a mature trauma center with an aggressive trauma team activation system</atitle><jtitle>European journal of trauma and emergency surgery (Munich : 2007)</jtitle><stitle>Eur J Trauma Emerg Surg</stitle><addtitle>Eur J Trauma Emerg Surg</addtitle><date>2013-12-01</date><risdate>2013</risdate><volume>39</volume><issue>6</issue><spage>599</spage><epage>603</epage><pages>599-603</pages><issn>1863-9933</issn><eissn>1863-9941</eissn><abstract><![CDATA[Purpose
The American College of Surgeons Committee on Trauma (ACS-COT) has determined that a 5 % pre-hospital undertriage [UT; defined as Injury Severity Score (ISS) > 15 and not sent to a trauma center] is an acceptable rate for pre-hospital transfer to a non-trauma center. We sought to determine if this level of undertriage is acceptable within a mature Level II trauma center as a measure of the adequacy of its trauma activation system.
Methods
Our trauma activation system encompasses anatomic, physiologic, and mechanism of injury criteria. We defined UT as ISS > 15 and no trauma activation. All UT patients during the period 2000–2010 were compared to properly triaged patients (CT). The variables examined were mortality, emergency department (ED) length of stay (LOS), hospital LOS, complications, Coumadin use, and age >64 years.
Results
There were 18,324 patients admitted, with 1,156 (6.3 %) UT. UT is associated with an increase in mortality [odds ratio (OR) 3.0; 95 % confidence interval (CI) 2.4–3.8;
p
< 0.001), longer ED LOS (OR 54.5; 95 % CI 45.5–63.5;
p
< 0.001), and longer hospital LOS (OR 1.7; 95 % CI 1.4–2.1;
p
< 0.001). In addition, UT patients had a two-fold increase in complications (OR 2.0; 95 % CI 1.6–2.5;
p
< 0.001). When controlling for age ≥65 years, Revised Trauma Score (RTS) > 7.0, and one or more co-morbidities, UT patients had 2.18 times higher odds of mortality than their CT counterparts (OR 2.18; 95 % CI 1.57–3.01;
p
< 0.001). Patients on pre-hospital Coumadin (OR 3.61; 95 % CI 3.04–4.30;
p
< 0.001) and age >64 years (OR 4.93; 95 % CI 4.36–5.58;
p
< 0.001) were significant predictors of being undertriaged. A
p
-value ≤ 0.05 was considered to be significant.
Conclusions
Standard trauma activation criteria may not be adequate to identify the at-risk severely injured trauma patient. Further refinement of in-house trauma triage protocols is necessary if trauma centers are to improve outcomes following trauma.]]></abstract><cop>Berlin/Heidelberg</cop><pub>Springer Berlin Heidelberg</pub><pmid>26815543</pmid><doi>10.1007/s00068-013-0289-z</doi><tpages>5</tpages></addata></record> |
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| ispartof | European journal of trauma and emergency surgery (Munich : 2007), 2013-12, Vol.39 (6), p.599-603 |
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| subjects | Critical Care Medicine Emergency Medicine Intensive Medicine Medicine & Public Health Original Article Sports Medicine Surgery Surgical Orthopedics Traumatic Surgery |
| title | Increased mortality with undertriaged patients in a mature trauma center with an aggressive trauma team activation system |
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