The Respiratory Rate: A Neglected Triage Tool for Pre-hospital Identification of Trauma Patients

John D. Yonge, Phillip Kemp Bohan, Justin J. Watson, Christopher R. Connelly, Lynn Eastes, Martin Schreiber

    Research output: Contribution to journalArticle

    3 Citations (Scopus)

    Abstract

    Background: Under-triaged trauma patients have worse clinical outcomes. We evaluated the capability of four pre-hospital variables to identify this population at the lowest level trauma activation (level 3). Methods: A retrospective review of adult trauma activations from 2004 to 2014 was completed. Pre-hospital vital signs and Glasgow Coma Scale were converted to categorical variables. Patients were under-triaged based on meeting current level 1 or 2 criteria, or requiring a pre-defined critical intervention. Logistic regression was used to determine the association between the pre-hospital variables and under-triaged patients. Odds ratios and 95% confidence intervals were calculated for a comprehensive model, grouping all causes of under-triage as a single unit, and 16 individual models, one for each under-triage criterion. A new level 2 criterion was generated and internally validated. Results: In total, 12,332 activations occurred during the study period. Four hundred and sixty-six (5.9%) patients were under-triaged. Compared to patients with a normal respiratory rate (RR), tachypneic patients were more likely to be under-triaged for any reason, OR 1.7 [1.3–2.1], p < 0.001. In the individual event analysis, tachypneic patients were more likely to have flail chest, OR 22 [2.9–168.3], p = 0.003; require a chest tube, OR 3 [1.8–4.9], p < 0.001; or require emergent intubation, OR 1.6 [1.1–2.8], p = 0.04, compared to patients with a normal RR. The data-driven triage modification was tachypnea with suspected thoracic injury which reduced the under-triage rate by 1.2%. Conclusion: Tachypnea with suspected thoracic injury is the strongest level 2 triage modification to reduce level 3 under-triage.

    Original languageEnglish (US)
    Pages (from-to)1-6
    Number of pages6
    JournalWorld Journal of Surgery
    DOIs
    StateAccepted/In press - Dec 6 2017

    Fingerprint

    Triage
    Respiratory Rate
    Wounds and Injuries
    Tachypnea
    Thoracic Injuries
    Flail Chest
    Chest Tubes
    Glasgow Coma Scale
    Vital Signs
    Intubation
    Logistic Models
    Odds Ratio
    Confidence Intervals
    Population

    ASJC Scopus subject areas

    • Surgery

    Cite this

    The Respiratory Rate : A Neglected Triage Tool for Pre-hospital Identification of Trauma Patients. / Yonge, John D.; Bohan, Phillip Kemp; Watson, Justin J.; Connelly, Christopher R.; Eastes, Lynn; Schreiber, Martin.

    In: World Journal of Surgery, 06.12.2017, p. 1-6.

    Research output: Contribution to journalArticle

    Yonge, John D. ; Bohan, Phillip Kemp ; Watson, Justin J. ; Connelly, Christopher R. ; Eastes, Lynn ; Schreiber, Martin. / The Respiratory Rate : A Neglected Triage Tool for Pre-hospital Identification of Trauma Patients. In: World Journal of Surgery. 2017 ; pp. 1-6.
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    abstract = "Background: Under-triaged trauma patients have worse clinical outcomes. We evaluated the capability of four pre-hospital variables to identify this population at the lowest level trauma activation (level 3). Methods: A retrospective review of adult trauma activations from 2004 to 2014 was completed. Pre-hospital vital signs and Glasgow Coma Scale were converted to categorical variables. Patients were under-triaged based on meeting current level 1 or 2 criteria, or requiring a pre-defined critical intervention. Logistic regression was used to determine the association between the pre-hospital variables and under-triaged patients. Odds ratios and 95{\%} confidence intervals were calculated for a comprehensive model, grouping all causes of under-triage as a single unit, and 16 individual models, one for each under-triage criterion. A new level 2 criterion was generated and internally validated. Results: In total, 12,332 activations occurred during the study period. Four hundred and sixty-six (5.9{\%}) patients were under-triaged. Compared to patients with a normal respiratory rate (RR), tachypneic patients were more likely to be under-triaged for any reason, OR 1.7 [1.3–2.1], p < 0.001. In the individual event analysis, tachypneic patients were more likely to have flail chest, OR 22 [2.9–168.3], p = 0.003; require a chest tube, OR 3 [1.8–4.9], p < 0.001; or require emergent intubation, OR 1.6 [1.1–2.8], p = 0.04, compared to patients with a normal RR. The data-driven triage modification was tachypnea with suspected thoracic injury which reduced the under-triage rate by 1.2{\%}. Conclusion: Tachypnea with suspected thoracic injury is the strongest level 2 triage modification to reduce level 3 under-triage.",
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    AU - Yonge, John D.

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