(P2-91) EMS Trauma Triage: Does the Red-Blue Criteria Enable Overtriage?

Abstract

Introduction

With the current need for effective trauma center utilization, understanding how current trauma triage criteria may promote overtriage will enable both field and hospital teams to provide the most appropriate patient care. It is hypothesized that current Southwest Texas trauma criteria promote overtriage by prehospital emergency medical services (EMS) of patients in favor of a Level 1 trauma facility when compared to physician assessment and Injury Severity Score (ISS).

Methods

This prospective, observational study at a Southwest Texas military Level 1 trauma center compared adult trauma patients' prehospital status noted by EMS personnel with the triage criteria documented by the treating emergency physician. The patients were divided into four groups: Prehospital Criteria Met or Not Met; Arrival Criteria Met or Not Met. Each patient's ISS and mechanism of injury were also collected and compared to initial assessment for predictive value. Descriptive statistics were used.

Results

The study enrolled 278 adult trauma patients. EMS reported Level 1 trauma status similar to physician assessment (60.1% vs. 59.7%, respectively). The rates patients met Level 1 trauma status corresponded with trauma severity when compared to the ISS. Assessment between EMS and physicians for ISSs were similar among the four groups. Comparisons using multivariate analysis of the four groups found similar ISSs, except for the Prehospital Criteria Met/Arrival Criteria Not Met group. Seventy-five percent of these patients were assigned an ISS in the Minor (ISS < 9) category (p = 0.013).

Conclusion

Trauma triage criteria assessment skills were similar between EMS personnel and emergency physicians except for identifying minor trauma patients. While the criteria generally led to overtriage, EMS crews appear to overtriage minor trauma patients at a much higher rate.