M. Williams1, R. Griffin1, M. Minor1, D. Cox1, J. O. Jansen1, J. B. Holcomb1, J. D. Kerby1, Z. G. Hashmi1 1University Of Alabama at Birmingham, Birmingham, Alabama, USA
Introduction: The number of trauma patients transported to the only American College of Surgeons-verified Level-I trauma center in a predominantly rural state increased by 18% through the COVID-19 pandemic. However, the reasons behind this substantial increase remain unclear. Therefore, the objective of this study was to evaluate trends in primary and secondary triage of trauma patients to a level 1 trauma center in a predominantly rural state through the COVID-19 pandemic. We hypothesized that an increase in the number of secondary triage contributed significantly to the increase in overall trauma evaluations seen at our center.
Methods: A retrospective analysis of all trauma patients entered into the state-wide Trauma Communication Center (TCC) database between 2017-2021 was performed. This database captures initial emergency medical services (EMS) patient evaluation and communications data for injured patients across 6 distinct EMS regions across the state. Hospitals within the same EMS region as the Level-I trauma center were classified as “regional hospitals” whereas those outside the region were classified as “non-regional hospitals.” Yearly trends in volume and proportion of primary and secondary triage to the Level-I trauma center were examined. We also examined the trends in volume of trauma evaluations and the volume and rate of secondary triage to the Level-I center by regional and non-regional hospitals across the state.
Results: A total of 73,633 trauma patients entered into the TCC database were analyzed. Patients transported to the Level-I trauma center increased from 4,576 in 2017 to 5,389 in 2021. Figure 1a demonstrates that this increase in trauma volume was largely driven by an increase in primary triage (26% increase from 2017) while secondary triage volume remained largely unchanged (2% increase from 2017). Figure 1b shows a concurrent decrease in primary triage to both regional hospitals (43% decrease from 2017) and non-regional hospitals (22% decrease from 2017). Further evaluation revealed that among non-regional hospitals, most of the decrease in primary triage volume occurred at smaller hospitals (34% decrease from 2017) while larger hospitals recovered volume in 2021 (10% increase from 2017). While percentage change in rates of secondary triage to the Level-I trauma center increased among both regional (67% increase from 2017) and non-regional hospitals (31% increase from 2017), the volume of secondary triage remained unchanged.
Conclusion: This study shows that primary triage to a large Level-I trauma center increased significantly through the COVID-19 years. This increase resulted from a concurrent decrease in primary triage to both regional and non-regional hospitals in a predominantly rural state. Future work should focus on evaluating state-level surge capacity and implications of change in triage practices on patient outcomes.
