Role of Guideline Adherence In Improving Field Triage

Craig Newgard, Rongwei (Rochelle) Fu, E. Brooke Lerner, Mohamud Ramzan Daya, Jonathan Jui, Lynn Wittwer, Terri Schmidt, Dana Zive, Eileen M. Bulger, Ritu Sahni, Craig Warden, Nathan Kuppermann

Research output: Contribution to journalArticle

5 Citations (Scopus)

Abstract

Objective: To compare the sensitivity of current field triage practices for identifying high-risk trauma patients to strict guideline adherence, including changes in triage specificity, ambulance transport patterns, and trauma center volumes. Methods: This was a pre-planned secondary analysis of an out-of-hospital prospective cohort of injured children and adults transported by 44 EMS agencies to 28 trauma and non-trauma hospitals in 7 Northwest U.S. counties from January 1, 2011 through December 31, 2011. Outcomes included Injury Severity Score (ISS) ≥16 (primary) and early critical resource use. Strict adherence of the triage guidelines was based on evidence in the EMS chart for patients meeting any current field triage criteria, calculated with and without strict interpretation of the age criterion (<15 or >55 years). Due to the probability sampling nature of the cohort, strata and weights were included in all analyses. Results: 17,633 injured patients were transported by EMS (weighted to represent 53,487 transported patients), including 3.1% with ISS ≥16 and 1.7% requiring early critical resources. Field triage sensitivity for identifying patients with ISS ≥16 increased from the current 66.2% (95% CI 60.2–71.7%) to 87.3% (95% CI 81.9–91.2%) for strict adherence without age and to 91.0% (95% CI 86.4–94.2%) for strict adherence with age. Specificity decreased with increasing adherence, from 87.8% (current) to 47.6% (strict adherence without age) and 35.8% (strict adherence with age). Areas under the curve (AUC) were 0.78, 0.73, and 0.72, respectively. Results were similar for patients requiring early critical resources. We estimate the number of triage-positive patients transported each year by EMS to an individual major trauma center (on average) to increase from 1,331 (current) to 5,139 (strict adherence without age) and to 6,256 (strict adherence with age). Conclusions: The low sensitivity of current triage practices would be expected to improve with strict adherence to current triage guidelines, with a commensurate decrease in triage specificity and an increase in the number of triage-positive patients transported to major trauma centers.

Original languageEnglish (US)
Pages (from-to)1-11
Number of pages11
JournalPrehospital Emergency Care
DOIs
StateAccepted/In press - Apr 26 2017

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Guideline Adherence
Triage
Injury Severity Score
Trauma Centers
Northwestern United States
Ambulances
Wounds and Injuries
Area Under Curve
Guidelines

ASJC Scopus subject areas

  • Emergency Medicine
  • Emergency

Cite this

Role of Guideline Adherence In Improving Field Triage. / Newgard, Craig; Fu, Rongwei (Rochelle); Lerner, E. Brooke; Daya, Mohamud Ramzan; Jui, Jonathan; Wittwer, Lynn; Schmidt, Terri; Zive, Dana; Bulger, Eileen M.; Sahni, Ritu; Warden, Craig; Kuppermann, Nathan.

In: Prehospital Emergency Care, 26.04.2017, p. 1-11.

Research output: Contribution to journalArticle

Newgard, Craig ; Fu, Rongwei (Rochelle) ; Lerner, E. Brooke ; Daya, Mohamud Ramzan ; Jui, Jonathan ; Wittwer, Lynn ; Schmidt, Terri ; Zive, Dana ; Bulger, Eileen M. ; Sahni, Ritu ; Warden, Craig ; Kuppermann, Nathan. / Role of Guideline Adherence In Improving Field Triage. In: Prehospital Emergency Care. 2017 ; pp. 1-11.
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AU - Daya, Mohamud Ramzan

AU - Jui, Jonathan

AU - Wittwer, Lynn

AU - Schmidt, Terri

AU - Zive, Dana

AU - Bulger, Eileen M.

AU - Sahni, Ritu

AU - Warden, Craig

AU - Kuppermann, Nathan

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N2 - Objective: To compare the sensitivity of current field triage practices for identifying high-risk trauma patients to strict guideline adherence, including changes in triage specificity, ambulance transport patterns, and trauma center volumes. Methods: This was a pre-planned secondary analysis of an out-of-hospital prospective cohort of injured children and adults transported by 44 EMS agencies to 28 trauma and non-trauma hospitals in 7 Northwest U.S. counties from January 1, 2011 through December 31, 2011. Outcomes included Injury Severity Score (ISS) ≥16 (primary) and early critical resource use. Strict adherence of the triage guidelines was based on evidence in the EMS chart for patients meeting any current field triage criteria, calculated with and without strict interpretation of the age criterion (<15 or >55 years). Due to the probability sampling nature of the cohort, strata and weights were included in all analyses. Results: 17,633 injured patients were transported by EMS (weighted to represent 53,487 transported patients), including 3.1% with ISS ≥16 and 1.7% requiring early critical resources. Field triage sensitivity for identifying patients with ISS ≥16 increased from the current 66.2% (95% CI 60.2–71.7%) to 87.3% (95% CI 81.9–91.2%) for strict adherence without age and to 91.0% (95% CI 86.4–94.2%) for strict adherence with age. Specificity decreased with increasing adherence, from 87.8% (current) to 47.6% (strict adherence without age) and 35.8% (strict adherence with age). Areas under the curve (AUC) were 0.78, 0.73, and 0.72, respectively. Results were similar for patients requiring early critical resources. We estimate the number of triage-positive patients transported each year by EMS to an individual major trauma center (on average) to increase from 1,331 (current) to 5,139 (strict adherence without age) and to 6,256 (strict adherence with age). Conclusions: The low sensitivity of current triage practices would be expected to improve with strict adherence to current triage guidelines, with a commensurate decrease in triage specificity and an increase in the number of triage-positive patients transported to major trauma centers.

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