P. P. Parikh1, B. Zoll1, P. Parikh1, K. Hendershot1, M. Whitmill1, T. Erskine2, S. Schmidt2, R. Woods1, J. Saxe1 1Wright State University,Dayton, OH, USA 2Emergency Medical Services,Ohio Department Of Public Safety,Columbus, OH, USA
Introduction: The trauma system has not produced the expected impact on patient safety and resource utilization in the state of Ohio. We, therefore, undertook a study with the Ohio Department of Public Safety (ODPS) to identify the contributing clinical and system-level factors affecting the four outcomes; overtriage, undertriage, mortality, and transfers.
Methods: All trauma and emergency medical services (EMS) data for 2008-2012 were obtained from the ODPS, which included 35,631 unique patient records. Overtriage (OT) rate was defined as the proportion of patients with ISS≤15 transported to a Level I/II trauma center; undertriage (UT) referred to patients ISS>15 transported to a non-trauma center. Statistical analysis was used to compare proportions of patients experiencing OT and UT, and subsequent mortality and transfers, across several factors where OT and transfers indicate resource utilization, and UT and mortality directly impact patient care.
Results:OT and UT rates were 43.03% and 3.06%, respectively. We confirm a previous finding that patient/family choice (41.24%) was the top reason for triage decisions; most appropriate closest facility (34.28%) and protocol (14.92%) followed. With increasing patient age triage decisions based on patient/family choice nearly doubled (from 26% to 51%), and OT and transfer rates decreased substantially. Interestingly, the UT rates remained fairly stable unlike a recent study suggesting an increase. The highest inter-facility transfers (21.83%; p<0.05) were observed when the triage decision was based on the most appropriate closest facility, which likely resulted from resuscitating the patient at a nearby non-trauma center first before transferring them to a trauma facility. However, when triage decisions were based on protocol, the OT rates (46.5%; p<0.05) and mortality rates (7.02%; p<0.05) were among the highest (Table 1), the reasons for which were unclear.
Conclusion:This work addresses several concerns related to on-field trauma triage currently under review within the state of Ohio. The findings in this study serve as building blocks to further our understanding of reasons for high mortality and transfer rates in an effort to potentially develop a new on-field triage model.
