Trauma team activation for 'mechanism of injury' blunt trauma victims: time for a change?
Excessive overtriage prompted a review of all stable blunt trauma victims < or = age 65 years transported to our trauma center from 1990 through 1992 only by virtue of mechanism of injury. Of 4392 blunt trauma patients, 2298 (52%) met review criteria. In this group 1712 (75%) were discharged home from the emergency room, and 586 were hospitalized: 367 (63%) for < or = 1 day; 465 (79%) for < or = 2 days. Of 93 ICU patients, 61 (66%) stayed < or = 24 hours, and 78 (84%) < or = 48 hours. Most ICU admissions were for neurologic or cardiac monitoring. The mean ISS of the population was < or = 2.8; only 15 patients had an ISS > or = 16. No patient required urgent transfer from the emergency room to the operating room for hemodynamic or neurologic instability. Four patients (0.17%) had early surgery following appropriate radiologic evaluation and underwent hemisplenectomy; brachial artery repair; ligation of a mesenteric bleeder; or evacuation of a subdural hematoma. Early open reduction/internal fixation of extremity fractures was done in 22 other patients (0.96%). Initial trauma team evaluation of hemodynamically stable blunt trauma victims whose only reason for trauma center transport is mechanism of injury is needlessly labor intensive and is not cost effective. Rather, a competent trauma center emergency medicine physician should be able to safely perform an initial assessment of such patients and summon the surgery team for specific clinical or radiologic indicators.
Shatney
C H
CH
Department of Surgery, Santa Clara Valley Medical Center, San Jose, CA 95128.
Sensaki
K
K
D000328:Adult; D000368:Aged; D002648:Child; D002983:Clinical Competence; D003363:Cost Control; D004632:Emergency Medical Services / Q000191:economics; D004636:Emergency Service, Hospital / Q000458:organization & administration; D005260:Female; D006760:Hospitalization; D006801:Humans; D015601:Injury Severity Score; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D010348:Patient Care Team; D010351:Patient Discharge; D014194:Traumatology / Q000193:education; D014218:Triage / Q000191:economics / Q000379:methods*; D014949:Wounds, Nonpenetrating / Q000175:diagnosis / Q000601:surgery / Q000628:therapy*