Vehicular trauma triage by mechanism: avoidance of the unproductive evaluation

An instrument was developed using routinely available field data to identify the sizable subgroup of stable vehicular trauma victims initially triaged to the trauma center by mechanism indicators alone who are in reality at minimal risk for serious injury. The six most common vehicular mechanism indicators seen at a level I trauma center were evaluated: rollover, head-on greater than 30 mph, intrusion, prolonged extrication, other death in same vehicle, and ejection. Review of 1235 consecutive trauma team activations yielded 349 victims with a qualifying vehicular mechanism. Outcome indicators were used to classify patients into two groups: Minor Injury (MI) and Severe Injury (SI). Nineteen common field data elements routinely reported on arrival by the regional Emergency Medical Service (EMS) personnel were then reviewed. Data patterns associated only with the MI group were sought. A checklist was developed for Mechanism vehicular trauma utilizing physiologic, anatomic, and neurologic elements. A single positive element would define trauma team activations. Retrospectively, use of this instrument would have excluded 56% of the MI group from unproductive trauma team referral, but nearly none of the SI group. We conclude that an identifiable subset of trauma patients referred by vehicular mechanism criteria alone could be safely evaluated on arrival in the emergency department as a form of secondary triage rather than by referral to the trauma team. The use of an appropriate exclusionary instrument can still preserve the sensitivity of trauma team activation for severely injured victims.