title: Trauma system overtriage: are we on track?
abstract: The American College of Surgeons (ACS) recommends trauma overtriage rate (OT) below 50 per cent to maximize efficiency while ensuring optimal care. This retrospective study was undertaken to evaluate OT rates in our Level I trauma center using the most recent criteria and guidelines. OT rates during a 12-month period were measured using six definitions based on combinations of Injury Severity Score (ISS), length of hospital stay (LOS, in days), procedures, and disposition after the emergency department. Reason for trauma activation was 55 per cent criteria, 16 per cent guidelines, 11 per cent paramedic judgment, five per cent no reason, and 13 per cent no documentation. OT rates ranged from 22.6 per cent (ISS less than 9, LOS 1 day or less, no consults) to 48.2 per cent (ISS less than 9, LOS 3 days or less, with procedures/consults) and were in compliance with ACS recommendations. Physiologic assessment criteria and anatomic injury had the lowest OT rates and contained all mortalities. Passenger space intrusion (PSI), pedestrian versus automobile (criterion and guideline), and extrication (guideline) all had consistently high rates of OT. We conclude that PSI should be reduced to a guideline, the pedestrian versus automobile criterion and guideline should be combined, and extrication could be removed from the triage scheme.
authors.affiliation: David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, California, USA.
authors.forename: Zoe
authors.initials: Z
authors.lastname: Fullerton
authors.forename: Graham W
authors.initials: GW
authors.lastname: Donald
authors.forename: Henry G
authors.initials: HG
authors.lastname: Cryer
authors.forename: Catherine E
authors.initials: CE
authors.lastname: Lewis
authors.forename: Ali
authors.initials: A
authors.lastname: Cheaito
authors.forename: Marilyn
authors.initials: M
authors.lastname: Cohen
authors.forename: Areti
authors.initials: A
authors.lastname: Tillou
mesh_terms: D005260:Female; D019983:Guideline Adherence / Q000706:statistics & numerical data*; D006801:Humans; D015601:Injury Severity Score; D007902:Length of Stay; D015141:Los Angeles; D008297:Male; D017410:Practice Guidelines as Topic; D012189:Retrospective Studies; D014193:Trauma Centers / Q000592:standards* / Q000706:statistics & numerical data; D014218:Triage / Q000379:methods / Q000592:standards* / Q000706:statistics & numerical data