title: Assessing the feasibility of the American College of Surgeons' benchmarks for the triage of trauma patients.
abstract: OBJECTIVE
  To test the feasibility of accomplishing the American College of Surgeons Committee on Trauma benchmarks of less than 5% undertriage (treatment of patients with moderate to severe injuries at nontrauma centers [NTCs]) and less than 50% overtriage (transfer of patients with minor injuries to trauma centers [TCs]) given current practice patterns by describing transfer patterns for patients taken initially to NTCs and estimating volume shifts and potential lives saved if full implementation were to occur.
  
  
  METHODS
  Retrospective cohort study of adult trauma patients initially evaluated at NTCs in Pennsylvania (between April 1, 2001, and March 31, 2005). We used published estimates of mortality risk reduction associated with treatment at TCs.
  
  
  METHODS
  Undertriage and overtriage rates, estimated patient volume shifts, and number of lives saved.
  
  
  RESULTS
  A total of 93,880 adult trauma patients were initially evaluated at NTCs in Pennsylvania between 2001 and 2005. Undertriage was 69%; overtriage was 53%. Achieving less than 5% undertriage would require the transfer of 18,945 patients per year, a 5-fold increase from current practice (3650 transfers per year). Given an absolute mortality risk reduction of 1.9% for patients with moderate to severe injuries treated at TCs, this change in practice would save 99 potential lives per year or would require 191 transfers per year to save 1 potential life.
  
  
  CONCLUSIONS
  Given current practice patterns, American College of Surgeons Committee on Trauma recommendations for the regionalization of trauma patients may not be feasible. To achieve 5% undertriage, TCs must increase their capacity 5-fold, physicians at NTCs must increase their capacity to discriminate between moderate to severe and other injuries, or the guidelines must be modified.
authors.affiliation: Department of Surgery, University of Pittsburgh, Pittsburgh, PA 15261, USA. mohand@upmc.edu
authors.forename: Deepika
authors.initials: D
authors.lastname: Mohan
authors.forename: Matthew R
authors.initials: MR
authors.lastname: Rosengart
authors.forename: Coreen
authors.initials: C
authors.lastname: Farris
authors.forename: Elan
authors.initials: E
authors.lastname: Cohen
authors.forename: Derek C
authors.initials: DC
authors.lastname: Angus
authors.forename: Amber E
authors.initials: AE
authors.lastname: Barnato
mesh_terms: D000368:Aged; D019985:Benchmarking / Q000458:organization & administration*; D005240:Feasibility Studies; D005260:Female; D005500:Follow-Up Studies; D017052:Hospital Mortality / Q000639:trends; D006801:Humans; D008297:Male; D008875:Middle Aged; D010043:Outcome and Process Assessment, Health Care; D010414:Pennsylvania / Q000453:epidemiology; D017410:Practice Guidelines as Topic; D012189:Retrospective Studies; D018570:Risk Assessment / Q000379:methods*; D014193:Trauma Centers / Q000458:organization & administration*; D015599:Trauma Severity Indices; D014218:Triage / Q000592:standards*; D014947:Wounds and Injuries / Q000145:classification* / Q000175:diagnosis / Q000401:mortality