Nonsurgical Admissions With Traumatic Injury: Medical Patients Are Trauma Patients Too

Area of Science:

• Trauma Surgery
• Geriatric Trauma
• Healthcare Performance Improvement

Background:

• Nontrauma service (NTS) admissions are increasing due to more frequent ground-level falls in elderly patients.
• American College of Surgeons (ACS) mandates require evaluation of trauma patients admitted to non-trauma services for performance improvement.

Purpose of the Study:

• To enhance the process for defining and evaluating trauma patients admitted to nontrauma services.
• To develop and implement an algorithm for assessing the appropriateness of NTS admissions.

Main Methods:

• A scoring algorithm was created to evaluate NTS admission appropriateness.
• Trauma registry data were analyzed over two years in an ACS Level II trauma center.
• Statistical tests (chi-squared, Fisher exact) compared outcomes between NTS and trauma service (TS) admissions.

Main Results:

• The NTS admission rate decreased significantly, stabilizing between 8% and 10%.
• Mortality and overall complication rates were similar between NTS and TS admissions (p = .40 and .66).
• Length of stay was significantly lower for TS admissions compared to NTS admissions (p < .0001).

Conclusions:

• A scoring algorithm can effectively determine the appropriateness of NTS admissions.
• Registry-based outcome data validate the utility of this tool for comparing NTS and TS admissions.