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Published on: January 8, 2020
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ISS is not an appropriate tool to estimate overtriage
Paër-Sélim Abback1, Kelly Brouns2, Jean-Denis Moyer3
1Department of Anesthesiology and Critical Care, Beaujon Hospital, DMU Parabol, AP-HP.Nord, Paris, France. paer-selim.abback@aphp.fr.
Summary
Many trauma patients with lower injury severity scores still require significant trauma center resources and interventions. Triage should prioritize clinical outcomes over anatomical criteria for better patient care.
Area of Science:
- Trauma Surgery
- Emergency Medicine
- Healthcare Resource Utilization
Background:
- Trauma centers (TCs) are equipped with specialized resources for severe injuries.
- Overtriage, admitting patients not needing TC resources, is a concern.
- Assessing the benefit of TC resources for lower-severity trauma is crucial.
Purpose of the Study:
- To evaluate resource utilization and patient outcomes for individuals with an Injury Severity Score (ISS) below 15 admitted to a Level 1 Trauma Center.
- To determine the actual benefit derived from specialized trauma center care in this patient cohort.
Main Methods:
- Retrospective analysis of a prospective cohort of patients with suspected severe trauma admitted to a Level 1 TC.
- Inclusion criteria: ISS < 15.
- Primary outcome: Surgery or interventional radiology within 24 hours of admission.
Main Results:
- 1409 patients with ISS < 15 were included (46.4% overtriage rate).
- 43.4% of these patients received emergency interventions (surgery, interventional radiology) within 24 hours.
- 16.9% had severe outcomes, and 38% had non-severe outcomes.
Conclusions:
- Patients with ISS < 15 admitted to a TC consume significant resources and may present with severe outcomes.
- Current triage systems may not accurately reflect the need for TC-specific care.
- Triage decisions should consider resource use and clinical outcomes, not solely anatomical criteria.
