Mechanism of injury does not predict acuity or level of service need: field triage criteria revisited.
BACKGROUND
Trauma systems use specific criteria based on physiologic, anatomic, and mechanistic factors for field triage. The purpose of this study was to evaluate the emergency department disposition of patients not meeting mandatory criteria (ie, physiologic or anatomic factors) for triage to a trauma center and the potential for over- or undertriage.


METHODS
This was a retrospective review of trauma admissions from July 1999 to June 2001, to a level I trauma center. Triage criteria were classified as physiologic factors (n=300), anatomic factors (n=115), or mechanistic factors (n=414), according to the criteria of the American College of Surgeons Committee on Trauma. Physiologic and anatomic factors were combined and compared with mechanistic factors.


RESULTS
There were 1253 admissions during the study period. Sixty-six percent (n=830) met study inclusion criteria. Fifty percent (n=413) were admitted to the intensive care unit or operating room. Approximately 50% of each group (physiologic/anatomic, 52%; mechanistic, 47%; P=.08) were admitted directly to the operating room or to the intensive care unit.


CONCLUSIONS
Patients not meeting mandatory criteria for transfer to a trauma center often have serious injuries that require a higher level of care. The inclusion of all or select mechanistic criteria for evaluation at a trauma center is appropriate to achieve an acceptable rate of clinical undertriage, as well as resource undertriage and its subsequent complications.
Santaniello
John M
JM
Division of Trauma, Critical Care and Burns, Department of Surgery, Stritch School of Medicine, Loyola University Medical Center, 2160 South First Avenue, Maywood, IL 60153, USA. jsantan@lumc.edu
Esposito
Thomas J
TJ
Luchette
Fred A
FA
Atkian
Debbie K
DK
Davis
Kimberly A
KA
Gamelli
Richard L
RL
D004636:Emergency Service, Hospital; D006801:Humans; D007362:Intensive Care Units / Q000706:statistics & numerical data; D009873:Operating Rooms / Q000706:statistics & numerical data; D010343:Patient Admission / Q000706:statistics & numerical data; D012189:Retrospective Studies; D014193:Trauma Centers; D014218:Triage / Q000379:methods*