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A Prospective Study

Ryan Lehmann, DO; Lionel Brounts, MD; Kelly Lesperance, MD; Matthew Eckert, MD; Linda Casey, RN; Alec Beekley, MD; Matthew Martin, MD

Arch Surg. 2009;144(9):853-858.

Background  Many trauma systems have adopted complex triage algorithms that are difficult to use and contain poorly validated variables.

Objective  To prospectively evaluate the performance of our institution's current triage system compared with a simplified system using only 4 highly predictive variables.

Design, Setting, and Patients  A prospective observational study of trauma patients in a 9-month period at an academic level II trauma center was undertaken. All trauma admissions were analyzed for the need for immediate emergency interventions or operative procedures. The accuracy and safety of the current triage system was compared with a simplified triage protocol using only 4 variables (hypotension, mental status, altered respirations, and penetrating truncal wound). Overtriage and undertriage rates were compared, and detailed analysis of all undertriaged patients was performed.

Main Outcome Measures  Rates of overtriage, undertriage, morbidity, and mortality.

Results  There were 244 trauma team activations, with 21% requiring urgent intervention. Existing criteria produced an overtriage rate of 79%, an undertriage rate of 1%, and mistriage in 14%. Using the simplified criteria, the overtriage rate was reduced to 12% and the undertriage rate was increased to 4% (both P < .05). Undertriaged patients were all hemodynamically stable, with 4 requiring tube thoracostomy only and 4 undergoing nonemergent laparotomy (2 nontherapeutic laparotomies, 1 bladder repair, and 1 bowel mesenteric injury). There were no deaths among undertriaged patients with either system.

Conclusions  Using a simplified triage system can safely reduce the rate of overtriage. This could conserve resources, reduce mistriage from misunderstood guidelines, and improve specificity by including only those variables with high predictive value.

Author Affiliations: Department of Surgery, Madigan Army Medical Center, Tacoma, Washington.

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