title: Compliance with Centers for Disease Control and Prevention field triage guidelines in an established trauma system.
abstract: BACKGROUND
  Regionalization of trauma care reduces mortality and has clear guidelines for transport to the highest level of trauma care. Whether prehospital providers follow the CDC triage algorithm remains to be determined.
  
  
  METHODS
  We performed a 5-year retrospective cohort analysis of linked data from Washington State's Central Region Trauma Registry (CRTR) and King County Emergency Medical Services (KCEMS). Patients were analyzed based on transport to their designated hospital, as determined by geocode mapping, or directly to the level I center (no level II center is available in this region).
  
  
  RESULTS
  Of the 12,106 patients in the study, 5,976 (49.4%) were transported directly to a level I center from the scene. Of the remaining 6,130 patients initially transported to level III to V centers, 5,024 (41.5%) remained in the respective level III to V centers and 1,106 (9.1%) were transferred to the level I center. Patients transported directly to a level I center were more likely to be male, younger, have a penetrating injury, lower scene Glasgow Coma Scale (GCS), lower scene blood pressure, and be more severely injured. Level I direct scene transport was significantly less likely for older patients. Compared with patients ages 18 to 45, the adjusted odds ratio for direct transport to the level I center was 0.7 (95% CI 0.59 to 0.83) for patients aged 46 to 55 years; 0.47 (95% CI 0.39 to 0.57) for those 56 to 65 years; 0.28 (95% CI 0.23 to 0.34) for patients 66 to 80 years; and 0.11 (95% CI 0.09 to 0.14) for those older than 81 years.
  
  
  CONCLUSIONS
  Prehospital providers follow physiologic, anatomic, and mechanistic parameters in steps 1 to 3 of the CDC field triage guidelines. However, contrary to the special considerations guideline in step 4, older age was associated with transport to the lower level of trauma care in our region.
authors.affiliation: Department of Surgery, Harborview Medical Center, University of Washington, Seattle, WA 98104, USA.
authors.forename: Alexis M
authors.initials: AM
authors.lastname: Gage
authors.forename: Neal
authors.initials: N
authors.lastname: Traven
authors.forename: Frederick P
authors.initials: FP
authors.lastname: Rivara
authors.forename: Gregory J
authors.initials: GJ
authors.lastname: Jurkovich
authors.forename: Saman
authors.initials: S
authors.lastname: Arbabi
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002487:Centers for Disease Control and Prevention, U.S.; D015331:Cohort Studies; D003663:Decision Trees; D005260:Female; D019983:Guideline Adherence / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D013997:Time Factors; D014193:Trauma Centers / Q000592:standards*; D014218:Triage / Q000592:standards*; D014481:United States; D055815:Young Adult