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Do outcome measures for trauma triage agree?
Sydney R Leach1, Robert A Swor, Raymond E Jackson
1Department of Emergency Medicine, William Beaumont Hospital, Royal Oak, Michigan 48085, USA. sleach@beaumonthospitals.com
Objective:
The goal of trauma triage is to match resources to the needs of seriously injured patients. The trauma triage literature has used a variety of outcome measures to assess appropriate trauma activation. The objective of this study was to determine the agreement between procedural and nonprocedural outcome measures in a population of seriously injured patients transported to a single trauma center.
Methods:
Study authors reviewed all "level 2" trauma activations (January 2002-December 2003) at an American College of Surgeons (ACS) Level 1 trauma center. "Level 2" trauma activations were based on modified ACS Committee on Trauma (COT) triage criteria. Outcomes were classified as nonprocedural (Injury Severity Score [ISS] > 15 and intensive care unit [ICU] admission) and procedural (nonorthopedic emergent surgery, emergency chest tube placement, emergency department intubation, emergency department transfusion, or emergent interventional radiology care).
Results:
Of 479 patients, five were transferred out of hospital. The remaining 474 were predominantly male (62%), with a mean age of 39.7 years. Their average ISS was 13.2. There were nine deaths. For all subjects, 144 (30%) were admitted to the ICU, 172 (36%) had an ISS > 15, 80 (17%) received an emergent procedure, and 46 (10%) went for emergent surgery. Kappas comparing agreement of ISS > 15 with emergent resuscitation and emergent surgery were 0.31 and 0.15, respectively. Kappas comparing ICU admission with emergent resuscitation and emergent surgery were 0.51 and 0.26, respectively.
Conclusions:
We identify moderate to poor agreement between nonprocedural and procedural outcomes of trauma triage in this population.
