title: Mechanism of injury and special consideration criteria still matter: an evaluation of the National Trauma Triage Protocol.
abstract: BACKGROUND
  The Centers for Disease Control recently updated the National Trauma Triage Protocol. This field triage algorithm guides emergency medical service providers through four decision steps (physiologic [PHY], anatomic [ANA], mechanism, and special considerations) to identify patients who would benefit from trauma center care. The study objective was to analyze whether trauma center need (TCN) was accurately predicted solely by the PHY and ANA criteria using national data.
  
  
  METHODS
  Trauma patients aged 18 years and older were identified in the NTDB (2002-2006). PHY data and ANA injuries (International Classification of Diseases, ninth revision codes) were collected. TCN was defined as Injury Severity Score (ISS)>15, intensive care unit admission, or need for urgent surgery. Test characteristics were calculated according to steps in the triage algorithm. Logistic regression was performed to determine independent association of criteria with outcomes. Receiver operating characteristic curves were constructed for each model.
  
  
  RESULTS
  A total of 1,086,764 subjects were identified. Sensitivity of PHY criteria was highest for ISS>15 (42%) and of ANA criteria for urgent surgery (37%). By using PHY and ANA steps, sensitivity was highest (56%) and undertriage lowest (45%) for ISS>15. Undertriage for TCN based on actual treating trauma center level was 11%.
  
  
  CONCLUSIONS
  Current PHY and ANA criteria are highly specific for TCN but result in a high degree of undertriage when applied independently. This implies that additional factors such as mechanism of injury and the special considerations included in the Centers for Disease Control decision algorithm contribute significantly to the effectiveness of this field triage tool.
authors.affiliation: Department of Surgery, University of Rochester School of Medicine, Rochester, New York 14642-8410, USA.
authors.forename: Joshua B
authors.initials: JB
authors.lastname: Brown
authors.forename: Nicole A
authors.initials: NA
authors.lastname: Stassen
authors.forename: Paul E
authors.initials: PE
authors.lastname: Bankey
authors.forename: Ayodele T
authors.initials: AT
authors.lastname: Sangosanya
authors.forename: Julius D
authors.initials: JD
authors.lastname: Cheng
authors.forename: Mark L
authors.initials: ML
authors.lastname: Gestring
mesh_terms: D000465:Algorithms; D016009:Chi-Square Distribution; D002985:Clinical Protocols / Q000592:standards; D005260:Female; D015600:Glasgow Coma Scale; D006801:Humans; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D012044:Regression Analysis; D018709:Statistics, Nonparametric; D014193:Trauma Centers; D015599:Trauma Severity Indices; D014218:Triage / Q000379:methods / Q000592:standards*; D014947:Wounds and Injuries / Q000145:classification* / Q000601:surgery