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Emergency physician and nurse discretion accurately triage high-risk trauma patients

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European Journal of Trauma and Emergency Surgery Aims and scope Submit manuscript

Abstract

Purpose

Prehospital trauma team activation (TTA) criteria allow for early identification of severely injured trauma patients. Although most TTA criteria are objective, one TTA criterion is subjective: emergency provider discretion. The study objective was to define the ability of emergency department physician and nurse discretion to accurately perform prehospital triage of high risk trauma patients.

Methods

All highest level TTAs arriving to our American College of Surgeons (ACS)-verified Level 1 trauma center (06/2015–08/2020) were included. Exclusions were undocumented prehospital vitals or discharge disposition. At our institution, TTAs are triggered for standard ACS TTA criteria and age > 70 with traumatic mechanism other than ground level fall. Patients meeting ≥ 1 criterion apart from “Emergency Provider Discretion” were defined as Standard TTAs and patients meeting only “Emergency Provider Discretion” were defined as Discretion TTAs. Univariable/multivariable analyses compared injury data and outcomes.

Results

4540 patients met inclusion/exclusion criteria: 3330 (73%) Standard TTAs and 1210 (27%) Discretion TTAs. Discretion TTAs were younger (34 vs. 37 years, p < 0.001) and more frequently injured by penetrating trauma (38% vs. 33%, p = 0.008), particularly stab wounds (64% vs. 29%). Overtriage rates were comparable after Discretion vs. Standard TTAs (33% vs. 31%, p = 0.141). Blood transfusion < 4 h (31% vs. 32%, p = 0.503) and ICU admission ≥ 3 days (25% vs. 27%, p = 0.058) were comparable between groups. Discretion TTA was independently associated with increased need for emergent surgery (OR 1.316, p = 0.005).

Conclusions

Emergency provider discretion accurately identifies major trauma, with comparable rates of overtriage as standard TTA criteria. Discretion TTAs were as likely as Standard TTAs to require early blood transfusion and prolonged ICU stay. After controlling for confounders, Discretion TTAs were significantly more likely to require emergent surgical intervention. Emergency provider discretion should be recognized as a valid method of identifying major trauma patients at high risk of need for intervention.

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Funding

No funding was received for this study.

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Correspondence to Morgan Schellenberg.

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Conflict of interest

Authors Schellenberg, Docherty, Owattanapanich, Emigh, Lutterman, Karavites, Switzer, Wiepking, Chudnofsky, and Inaba declare that they have no conflict of interest.

Ethical approval

All procedures performed in this retrospective observational study involving human participants were in accordance with the ethical standards of the Institutional Review Board of the University of California (HS-20–00292) and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed consent

This study received a waiver for informed consent by the Institutional Review Board of the University of Southern California (HS-20–00292).

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Schellenberg, M., Docherty, S., Owattanapanich, N. et al. Emergency physician and nurse discretion accurately triage high-risk trauma patients. Eur J Trauma Emerg Surg 49, 273–279 (2023). https://doi.org/10.1007/s00068-022-02056-0

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  • DOI: https://doi.org/10.1007/s00068-022-02056-0

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