R. L. Dailey1, M. Hutchison2, C. Mason2, K. Kimbrough2, B. Davis2, A. Bhavaraju2, R. Robertson2, K. Sexton2, J. Taylor2, B. Beck2 1University of Arkansas for Medical Sciences,College of Medicine,Little Rock, AR, USA 2University of Arkansas for Medical Sciences,Trauma Surgery,Little Rock, AR, USA
Introduction: EMS triage criteria determines if a patient receives the appropriate level of care. Increased mortality has been associated with triage of severely injured patients to hospitals who cannot provide definitive care, resulting in inter-hospital transfer (Nirula et al.). From the limited research, findings indicate EMS criteria is relatively insensitive for identifying seriously injured patients (Newgard; van Rein et al.). We hypothesized that trauma triage category would correlate with ISS.
Methods: This is a retrospective observational study of trauma patients transported to the state’s only level 1 trauma center.
Results: After excluding four patients for lack of assignment of trauma triage category and 16 patients with a designation of chief complaint not blunt or penetrating, 516 patients underwent final analysis. Additionally, patients missing either ISS, NISS, or TRISS scores were excluded in analysis involving these categories. When compared to trauma triage categories of minor (mn), moderate (md), and major (mj), ISS > 15 (p < .0001), mortality (p < .0001), and GCS category (p < .0001) were found to be significantly different according to chi square test for independence. Likewise, when compared to trauma triage category, ISS (mj: 16 ± 15.0, md: 9.4 ± 7.4, mn: 6.2 ± 6.1; p < .0001), NISS (mj: 21.6 ± 20.2, md: 11.7 ± 9.3, mn: 8.1 ± 8.3; p < .0001), and TRISS (mj: 0.81 ± 0.32, md: 0.98 ± 0.041, mn: 0.98 ± 0.028; p < .0001) were found to be significantly different according to ANOVA. Tukey post hoc analysis revealed significant differences (p < .0001) between the major and moderate and major and minor categories in ISS, NISS, and TRISS; whereas, the difference between moderate and minor categories were not significant in ISS (p = 0.0129), NISS (p = 0.0415), and TRISS (p = 0.9998). Percentages of patients discharged by emergency department services were as follows: mj: 18.9%, md: 19.2%, mn: 25.3%.
Conclusion: Results indicate that moderate and minor trauma triage categories are similar across ISS, NISS, and TRISS. This implies a lack of sensitivity in criteria to distinguish these categories. The scores (ISS, NISS, and TRISS) were more differentiated between major and moderate and major and minor categories. Results suggest that three categories of trauma triage may not be needed, or that additional parameters are needed to better define moderate and minor triage categories. In response to this study and findings from Newgard and Van Rein et al., future research should focus on improving prehospital trauma triage protocols.
