Effectiveness of a 2-specialty, 2-tiered triage and trauma team activation protocol.
OBJECTIVE
To determine the effectiveness, safety, and resource allocation of a 2-specialty, 2-tiered triage and trauma team activation protocol.


METHODS
We conducted a 6-month retrospective analysis of a 2-specialty, 2-tiered trauma team activation system at an urban Level I trauma center. Based on prehospital data, patients with a high likelihood of serious injury were assigned to triage category 1 and patients with a low likelihood of serious injury were assigned to category 2. Category 1 patients were immediately evaluated by both emergency medicine and trauma services. Category 2 patients were evaluated initially by emergency medicine staff with a mandatory trauma service consultation. Main outcomes measured included mortality, need for emergency procedures, need for emergency surgery, complications, and discharge disposition. Potential physician-hours saved were calculated for category 2 cases.


RESULTS
Five hundred sixty-one patients were assigned a triage classification (272 to category 1 and 289 to category 2). Category 1 patients had a higher mortality rate (95% confidence interval [CI] for difference of 15.9%, 11.1% to 20.7%, P < .0001), need for emergency surgery (10.7% versus 1.4%, 95% CI for difference of 9.3%, 5.2% to 13.4%; P < .0001), need for emergency procedures (89% of total procedures, 95% CI 83% to 95%; P < .0001), and discharges to rehabilitation facilities (95% CI for difference of 15.1%, 9.3% to 21.0%; P < .0001). The 2-tiered response system saved an estimated 578 physician-hours of time for the trauma service over the study period.


CONCLUSIONS
This evaluation tool effectively predicts likelihood of serious injury, mortality, need for emergency surgery, and need for rehabilitation. Patients with a low likelihood of serious injury may be initially evaluated by the emergency medicine service effectively and safely, thus allowing more efficient use of surgical personnel.
Department of Surgery, Case Western Reserve University School of Medicine, Cleveland, OH, USA.
B R
BR
Plaisier
S W
SW
Meldon
D M
DM
Super
N J
NJ
Jouriles
A L
AL
Barnoski
W F
WF
Fallon
M A
MA
Malangoni
D000465:Algorithms; D016009:Chi-Square Distribution; D004636:Emergency Service, Hospital / Q000458:organization & administration; D015276:Health Care Rationing; D006786:Hospitals, Urban / Q000458:organization & administration; D006801:Humans; D017063:Outcome Assessment, Health Care; D010348:Patient Care Team / Q000458:organization & administration*; D012189:Retrospective Studies; D018709:Statistics, Nonparametric; D014218:Triage / Q000458:organization & administration*