Refining triage practices by predicting the need for emergent care following major trauma: the experience of a level 1 adult trauma center

Abstract

Purpose: We examined the predictability of selected parameters for establishing the need for urgent care following multi-trauma as a means to warrant the highest level of trauma activation and potentially improve over- and under-triage rates.

Methods: In this retrospective cohort study of multi-trauma patients aged ≥ 16 years performed at a level 1 trauma center, trauma activation criteria and additional characteristics were examined with respect to treatment urgency, defined as: a direct disposition to the operating room or intensive care unit, initiating acute intervention in the trauma room, and in-hospital death within 7 days of admission.

Results: We enrolled 1373 patients (median age 36.0 years). The following parameter were inserted into the final multivariable model: age > 75 years, male sex, Charlson comorbidity index, trauma circumstances and mechanism, signs of respiratory distress, systolic BP ≤ 110 and GCS ≤ 13. Adjusted independent predictors of acute care requirement were as follows: GCS ≤ 13 (aOR 5.27 [95% CI 3.45-8.05], p < 0.001), systolic BP ≤ 110 mmHg (aOR 2.15 [95% CI 1.45-3.21], p < 0 .001), respiratory distress (aOR 2.05 [95% CI 1.53-2.77], p < 0.001), and age ≥ 75 years (aOR 1.90 [95% CI 1.18-3.08], p = 0.008).

Conclusion: A GCS ≤ 13, systolic BP < 110 mmHg, signs of respiratory distress, and age > 75 years best predicted the need for acute care following multisystem trauma. Prospective studies are warranted to confirm the predictability of these criteria and to assess the extent to which their implementation will refine over- and under-triage rates.

Keywords: Acute care; Emergency department; Multi-trauma; Trauma activation criteria.