title: The evaluation of a two-tier trauma response system at a major trauma center: is it cost effective and safe?
abstract: OBJECTIVE
  To determine the efficacy and safety of a two-tier trauma response, using prehospital criteria for matching trauma center assets with severity of injury.
  
  
  METHODS
  A prospective iterative study on a consecutive sample of patients to test the hypothesis.
  
  
  METHODS
  Criteria were developed whereby in-hospital response was determined by information provided by prehospital personnel. Two modifications of these criteria were introduced at 6 and 9 months. Triage and response accuracy were evaluated using outcome variables. Cost savings were estimated using differences between the full and modified teams. Chi-squared analysis was used.
  
  
  RESULTS
  Of 1,479 patients evaluated over a 9-month period, 682 (46%) received a full trauma team response, and a modified trauma team responded to 794 (54%). When compared with final designation by outcome variables, the sensitivity, specificity, and accuracy were significantly improved after the first modification of criteria. After the second modification, there was no significant improvement; however, the number of undertriaged patients increased significantly. Estimated cost savings were about $178,000 over the 9-month period.
  
  
  CONCLUSIONS
  Utilization of a two-tier response to trauma patients is effective, safe, and results in substantial cost savings.
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D003365:Costs and Cost Analysis; D004219:District of Columbia; D004632:Emergency Medical Services / Q000191:economics / Q000592:standards*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010865:Pilot Projects; D011446:Prospective Studies; D012494:Sampling Studies; D014193:Trauma Centers / Q000458:organization & administration / Q000592:standards*; D014218:Triage / Q000592:standards; D014947:Wounds and Injuries / Q000145:classification / Q000401:mortality / Q000628:therapy