title: Implementation of a two-tier trauma response.
abstract: OBJECTIVE
  To apply a triage tool to patients on their arrival in the emergency department and determine the efficacy and safety of a two-tier trauma response.
  
  
  METHODS
  Descriptive prospective audit.
  
  
  METHODS
  Principal urban referral hospital that provides a major trauma service.
  
  
  METHODS
  The triage tool designated a major trauma or stable trauma response. A major trauma designation mobilised a multidisciplinary team and a stable trauma designation an expedited evaluation by emergency department staff. Chi-square test and Mann-Whitney U test were used to compare major and stable trauma designations. Triage accuracy was evaluated using outcome variables.
  
  
  RESULTS
  78% of 58 major trauma responses and 30% of 180 stable trauma responses were admitted. The median injury severity score (and interquartile range) of admitted patients was 9.0 (5.0-19.5) for major responses and 5.0 (2.0-9.0) for stable responses. The triage tool had a sensitivity of 65%, specificity of 87%, accuracy (appropriate triage rate) of 82%, undertriage rate of 8% and overtriage rate of 10%.
  
  
  CONCLUSIONS
  The triage tool adequately distinguished between patients with and without major trauma. Undertriaged patients had timely and appropriate referral for definitive surgical care and had no adverse outcomes.
authors.affiliation: Department of Emergency Medicine, Westmead Hospital, NSW, Australia.
authors.forename: J M
authors.initials: JM
authors.lastname: Ryan
authors.forename: P L
authors.initials: PL
authors.lastname: Gaudry
authors.forename: P A
authors.initials: PA
authors.lastname: McDougall
authors.forename: P J
authors.initials: PJ
authors.lastname: McGrath
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002675:Child, Preschool; D002985:Clinical Protocols; D004636:Emergency Service, Hospital / Q000458:organization & administration*; D005260:Female; D006760:Hospitalization; D006786:Hospitals, Urban / Q000458:organization & administration; D006801:Humans; D015601:Injury Severity Score; D008297:Male; D008485:Medical Audit; D008875:Middle Aged; D009517:New South Wales; D011446:Prospective Studies; D014193:Trauma Centers / Q000458:organization & administration; D014218:Triage / Q000379:methods*; D014947:Wounds and Injuries / Q000145:classification* / Q000628:therapy