title: Accuracy of initial critical care triage decisions in blast versus non-blast trauma.
abstract: OBJECTIVE
  We investigated the accuracy of initial critical care triage in blast-injured versus non-blast-injured trauma patients, focusing on those inappropriately triaged to the intensive care unit (ICU) for brief (<16 h) stays.
  
  
  METHODS
  We conducted a retrospective review of the Israel National Trauma Registry, applying a predetermined definition of need for initial ICU admission.
  
  
  RESULTS
  A total of 883 blast-injured and 112 185 non-blast-injured patients were categorized according to their need for ICU admission. Of these admissions, 5.7% in the blast setting and 8.4% in the non-blast setting were considered unnecessary. The sensitivity, specificity, and positive and negative likelihood ratios for the triage officers' decisions in assigning patients to the ICU were 95.5%, 98.8%, 77.2, and 0.05, respectively, in the blast setting, and 91.2%, 99.5%, 200.5, and 0.09, respectively, in the non-blast setting.
  
  
  CONCLUSIONS
  Triage officers do a better job sending to the ICU only those patients who require initial intensive care in the non-blast setting, though this is obscured by a much greater overall need for ICU-level care in the blast setting. Implementing triage protocols in the blast setting may help reduce the number of patients sent initially to the ICU for brief periods, thus increasing the availability of this resource.
authors.affiliation: National Center for Trauma and Emergency Medicine Research,The Gertner Institute for Health Policy and Epidemiology,Tel Hashomer,Israel.
authors.forename: Ari M
authors.initials: AM
authors.lastname: Lipsky
authors.affiliation: Division of Trauma and Emergency Surgery,Department of Surgery,Kaplan Medical Center,Rehovot,Israel.
authors.forename: Yoram
authors.initials: Y
authors.lastname: Klein
authors.affiliation: National Center for Trauma and Emergency Medicine Research,The Gertner Institute for Health Policy and Epidemiology,Tel Hashomer,Israel.
authors.forename: Adi
authors.initials: A
authors.lastname: Givon
authors.affiliation: Division of Anesthesiology and Critical Care Medicine,Soroka Medical Center,Beer Sheva,Israel.
authors.forename: Moti
authors.initials: M
authors.lastname: Klein
authors.affiliation: Department of Surgery,University of Medicine and Dentistry of New Jersey-Robert Wood Johnson Medical School,New Brunswick,New Jersey.
authors.forename: Jeffrey S
authors.initials: JS
authors.lastname: Hammond
authors.affiliation: National Center for Trauma and Emergency Medicine Research,The Gertner Institute for Health Policy and Epidemiology,Tel Hashomer,Israel.
authors.forename: Kobi
authors.initials: K
authors.lastname: Peleg
mesh_terms: D000293:Adolescent; D000328:Adult; D001753:Blast Injuries / Q000453:epidemiology* / Q000628:therapy; D003422:Critical Care / Q000379:methods / Q000592:standards* / Q000706:statistics & numerical data; D003657:Decision Making; D005069:Evaluation Studies as Topic; D005260:Female; D006801:Humans; D007362:Intensive Care Units / Q000592:standards / Q000706:statistics & numerical data; D007557:Israel / Q000453:epidemiology; D008297:Male; D054527:Mass Casualty Incidents / Q000706:statistics & numerical data*; D008875:Middle Aged; D010343:Patient Admission / Q000592:standards / Q000706:statistics & numerical data; D012042:Registries; D012189:Retrospective Studies; D015599:Trauma Severity Indices; D014218:Triage / Q000379:methods / Q000592:standards* / Q000706:statistics & numerical data; D055815:Young Adult