Physiologic trauma triage criteria in adult trauma patients: are they effective in saving lives by transporting patients to trauma centers?
BACKGROUND
Trauma triage criteria have been in place for many years and were updated in 1999 by the American College of Surgeons. We are unaware of any studies that have directly examined the ability of these criteria to reduce short-term mortality by transporting patients to trauma centers rather than to noncenters.


METHODS
Retrospective observational cohort study of adult patients meeting physiologic triage criteria who were transported to 9 regional (Level I) trauma centers, 21 area (Level II) trauma centers, and 119 noncenters in New York in 1996 to 1998. For each triage criterion and for one or more of the criteria, odds ratios and their confidence intervals for mortality in regional and area trauma centers versus noncenters and odds ratios and their confidence intervals for mortality in regional centers versus area centers and noncenters were used to measure performance.


RESULTS
Patients in regional trauma centers had considerably lower mortality than patients in area trauma centers and noncenters for two individual triage criteria and for patients with one or more triage criteria (odds ratio, 0.75; 95% CI, 0.63-0.90 for one or more criteria). Also, patients with head injuries who were treated in regional centers had notably lower mortality than patients in other hospitals (odds ratio, 0.67; 95% CI, 0.53-0.85).


CONCLUSIONS
In New York, regional trauma centers exhibit considerably lower mortality than area trauma centers or noncenters for adult patients meeting specific physiologic triage criteria. It is important that population-based trauma systems with data from centers and noncenters be developed for the purpose of evaluating and redesigning trauma systems.
Hannan
Edward L
EL
Department of Health Policy, Management, and Behavior, University at Albany School of Public Health, Albany, NY 12144, USA.
Farrell
Louise Szypulski
LS
Cooper
Arthur
A
Henry
Mark
M
Simon
Bruce
B
Simon
Ronald
R
D000293:Adolescent; D000328:Adult; D005260:Female; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D009518:New York; D012042:Registries; D012189:Retrospective Studies; D014187:Transportation of Patients / Q000592:standards*; D014193:Trauma Centers / Q000706:statistics & numerical data*; D015599:Trauma Severity Indices; D014218:Triage / Q000592:standards*; D014947:Wounds and Injuries / Q000401:mortality*