Evaluation of a Consensus-Based Criterion Standard Definition of Trauma Center Need for Use in Field Triage Research.
Research on field triage of injured patients is limited by the lack of a widely used criterion standard for defining trauma center need. Injury Severity Score (ISS) >15 has been a commonly used outcome measure in research for determining trauma center need that has never been validated. A multidisciplinary team recently published a consensus-based criterion standard definition of trauma center need, but this measure has not yet been validated. The objective was to determine if the consensus-based criterion standard can be obtained by medical record review and compare patients identified as needing a trauma center by the consensus-based criterion standard vs. ISS >15. A subanalysis of data collected during a 2-year prospective cohort study of 4,528 adult trauma patients transported by EMS to a single trauma center was conducted. These data included ICD-9-CM codes, treatment times, and other patient care data. Presence of the consensus-based criterion standard was determined for each patient. ISS was calculated based on ICD-9-CM codes assigned for billing. The consensus-based criterion standard could be applied to 4,471 (98.7%) cases. ISS could be determined for 4,506 (99.5%) cases. Based on an ISS >15, 8.9% of cases were identified as needing a trauma center. Of those, only 48.2% met the consensus-based criterion standard. Almost all patients that did not meet the consensus-based criterion standard, but had an ISS >15 were diagnosed with chest (rib fractures (100/205 cases)/pneumothorax (57/205 cases), closed head (without surgical intervention 88/205 cases), vertebral (without spinal cord injury 45/205 cases), and/or extremity injuries (39/205 cases). There were 4,053 cases with an ISS <15. 5.0% of those with an ISS <15 met the consensus-based criterion standard with the majority requiring surgery (139/203 cases) or a blood transfusion (60/203 cases). The kappa coefficient of agreement for ISS and the consensus-based criterion standard was 0.43. We determined that the consensus-based criterion standard could be identified through a medical record review. Use of the consensus-based criterion standard for field triage research will more accurately identify injured patients who need the resources of a trauma center when compared to ISS.
Brian D
BD
Willenbring
E Brooke
EB
Lerner
Karen
K
Brasel
Jeremy T
JT
Cushman
Clare E
CE
Guse
Manish N
MN
Shah
Robert
R
Swor
D000328:Adult; D032921:Consensus; D004632:Emergency Medical Services / Q000592:standards*; D004638:Emergency Treatment; D005260:Female; D006801:Humans; D015601:Injury Severity Score; D038801:International Classification of Diseases; D008297:Male; D011446:Prospective Studies; D019984:Quality Indicators, Health Care; D014193:Trauma Centers / Q000592:standards* / Q000706:statistics & numerical data*; D014218:Triage
emergency medical services; field triage; trauma centers; wounds and injury