title: Cost-Effectiveness of Field Trauma Triage among Injured Adults Served by Emergency Medical Services.
abstract: The American College of Surgeons Committee on Trauma sets national targets for the accuracy of field trauma triage at ≥95% sensitivity and ≥65% specificity, yet the cost-effectiveness of realizing these goals is unknown. We evaluated the cost-effectiveness of current field trauma triage practices compared with triage strategies consistent with the national targets.
  
  
  
  This was a cost-effectiveness analysis using data from 79,937 injured adults transported by 48 emergency medical services agencies to 105 trauma and nontrauma hospitals in 6 regions of the western United States from 2006 through 2008. Incremental differences in survival, quality-adjusted life years (QALYs), costs, and the incremental cost-effectiveness ratio (costs per QALY gained) were estimated for each triage strategy during a 1-year and lifetime horizon using a decision analytic Markov model. We considered an incremental cost-effectiveness ratio threshold of <$100,000 to be cost-effective.
  
  
  
  For these 6 regions, a high-sensitivity triage strategy consistent with national trauma policy (sensitivity 98.6%, specificity 17.1%) would cost $1,317,333 per QALY gained, and current triage practices (sensitivity 87.2%, specificity 64.0%) cost $88,000 per QALY gained, compared with a moderate sensitivity strategy (sensitivity 71.2%, specificity 66.5%). Refining emergency medical services transport patterns by triage status improved cost-effectiveness. At the trauma-system level, a high-sensitivity triage strategy would save 3.7 additional lives per year at a 1-year cost of $8.78 million, and a moderate sensitivity approach would cost 5.2 additional lives and save $781,616 each year.
  
  
  
  A high-sensitivity approach to field triage consistent with national trauma policy is not cost-effective. The most cost-effective approach to field triage appears closely tied to triage specificity and adherence to triage-based emergency medical services transport practices.
authors.affiliation: Center for Policy and Research in Emergency Medicine, Department of Emergency Medicine, Oregon Health and Science University, Portland, OR. Electronic address: newgardc@ohsu.edu.
authors.forename: Craig D
authors.initials: CD
authors.lastname: Newgard
authors.affiliation: Department of Health Policy and Management, Rollins School of Public Health, Emory University, Atlanta, GA.
authors.forename: Zhuo
authors.initials: Z
authors.lastname: Yang
authors.affiliation: Department of Emergency Medicine, University of California at Davis, Sacramento, CA.
authors.forename: Daniel
authors.initials: D
authors.lastname: Nishijima
authors.affiliation: Center for Policy and Research in Emergency Medicine, Department of Emergency Medicine, Oregon Health and Science University, Portland, OR; Center for Health Systems Effectiveness, Department of Emergency Medicine, Oregon Health and Science University, Portland, OR.
authors.forename: K John
authors.initials: KJ
authors.lastname: McConnell
authors.affiliation: Department of Emergency Medicine, Denver Health Medical Center, Denver, CO; Department of Epidemiology, Colorado School of Public Health, University of Colorado School of Medicine, Aurora, CO.
authors.forename: Stacy A
authors.initials: SA
authors.lastname: Trent
authors.affiliation: Department of Emergency Medicine, University of California at Davis, Sacramento, CA.
authors.forename: James F
authors.initials: JF
authors.lastname: Holmes
authors.affiliation: Center for Policy and Research in Emergency Medicine, Department of Emergency Medicine, Oregon Health and Science University, Portland, OR.
authors.forename: Mohamud
authors.initials: M
authors.lastname: Daya
authors.affiliation: Department of Pediatrics, University of Utah School of Medicine, Salt Lake City, UT.
authors.forename: N Clay
authors.initials: NC
authors.lastname: Mann
authors.affiliation: Department of Emergency Medicine, Philip R. Lee Institute for Health Policy Studies, University of California at San Francisco, San Francisco General Hospital, San Francisco, CA.
authors.forename: Renee Y
authors.initials: RY
authors.lastname: Hsia
authors.affiliation: Department of Medicine, University of Washington, Seattle, WA.
authors.forename: Tom D
authors.initials: TD
authors.lastname: Rea
authors.affiliation: Department of Emergency Medicine, Stanford University, Palo Alto, CA.
authors.forename: N Ewen
authors.initials: NE
authors.lastname: Wang
authors.affiliation: Department of Surgery, Stanford University, Palo Alto, CA.
authors.forename: Kristan
authors.initials: K
authors.lastname: Staudenmayer
authors.affiliation: Department of Emergency Medicine, Center for Emergency Care Policy Research, Center for Clinical Epidemiology and Biostatistics, Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, PA.
authors.forename: M Kit
authors.initials: MK
authors.lastname: Delgado
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D019985:Benchmarking; D003362:Cost-Benefit Analysis; D003661:Decision Support Techniques; D004632:Emergency Medical Services / Q000191:economics* / Q000592:standards; D005260:Female; D006801:Humans; D008297:Male; D008390:Markov Chains; D008875:Middle Aged; D010043:Outcome and Process Assessment, Health Care; D019057:Quality-Adjusted Life Years; D012189:Retrospective Studies; D014187:Transportation of Patients / Q000191:economics / Q000592:standards; D014193:Trauma Centers; D014218:Triage / Q000191:economics* / Q000592:standards; D014481:United States; D014947:Wounds and Injuries / Q000175:diagnosis* / Q000191:economics / Q000401:mortality; D055815:Young Adult