This paper is only available as a PDF. To read, Please Download here.
Abstract
This pilot study was carried out to determine whether converting from a two-tier to
a three-tier in-hospital trauma triage system improves the efficiency of emergency
department (ED) care and minimizes inappropriate triage. Patients at an urban, Level
1 trauma centre were triaged using either a two-tier (months 1–3; n = 197) or three-tier (months 4–6; n = 240) trauma response system. Patients were assessed for triage type, age, sex,
injury severity score, Glasgow coma score, post-ED disposition, total ED time, survival,
complication rate, probability of survival and unexpected death. Comparisons were
made by ANOVA table analysis; significance was assumed for p < 0.05. Two-tier (n = 197) and three-tier patients (n = 240) were matched with respect to mean age, sex, mean injury severity score, mean
Glasgow coma score, post-ED disposition, survival and probability of survival. Two-tier
patients were triaged to give 20% alerts [criteria = physiological derangement (PD)
and/or injury mechanism (MOI)] and 80% consults; three-tier patients were triaged
as 20% category I (criteria = PD), 18% category II (criteria = MOI) and 62% consults.
Total ED time decreased from two-tier (3.98 ± 2.81 h) to three-tier triage (3.53 ±
2.14 h, p = 0.001). There was no difference between two-tier alert and three-tier category
I times (2.09 ± 1.64 vs. 1.95 ± 1.75 h; p = 0.72). Category II patients (3.28 ± 1.98 h; p = 0.009) spent less time in the ED than did two-tier consults (4.36 ± 2.65 h). The
mean ED three-tier consult time significantly decreased as well (3.95 ± 2.42 h, p = 0.008 vs. two-tier consult). Complications per patient were unchanged from two-tier
to three-tier triage (0.17 ± 0.52 vs. 0.12 ± 0.48; p = 0.15). Under-triage (5%) and over-triage (7.5%) were minimal under three-tier triage.
It is concluded that using a three-tier triage system results in an increase in the
early involvement of the trauma service while decreasing emergency department time
and minimizing overtriage.
To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to InjuryAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- Scoring system and triage from the field.Emergency Med Clinics. 1993; 11: 15
- The utility of physiologic status, injury site, and injury mechanism in identifying patients with major trauma.J Trauma. 1988; 28: 305
- The effect of regional trauma care systems on costs.Arch Surg. 1995; 130: 188
- Regional trauma system design: critical concepts.Am J Surg. 1987; 154: 79
- Optimizing prehospital triage criteria for trauma team alerts.J Trauma. 1993; 34: 127
- American College of Surgeons audit filters: associations with patient outcome and resource utilization.J Trauma. 1995; 38: 432
- Decreasing the cost of trauma care: a system of secondary in hospital triage.Ann Emerg Med. 1994; 23: 841
- Prehospital classification combined with an in-hospital trauma radio system response reduces cost and duration of evaluation of the injured patient.Surgery. 1995; 118: 789
- In-house board certified surgeons improve outcome for severely injured patients: a comparison of two university centers.J Trauma. 1993; 34: 871
- The evaluation of a two-tier trauma response system at a major trauma center: is it cost effective and safe?.J Trauma. 1995; 29: 971
Article info
Publication history
Accepted:
April 14,
1997
Identification
Copyright
© 1997 Published by Elsevier Inc.
