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Utilization of trauma nurse screening procedure for triage of the injured patient

Abstract

Purpose

The treatment of trauma patients requires significant hospital resources. Numerous protocols exist to triage the injured patient and determine the level of care they may require. The purpose of this work is to describe an institutional trauma nurse screening procedure and to evaluate its effectiveness in triaging injured patients.

Methods

This retrospective study was conducted at a large, tertiary trauma center from January to June 2021. Patients were assessed by trauma nurse clinicians (TNC) utilizing a standardized screening process to determine suitability for trauma activation. If the patient did not meet activation criteria, they were sent to the main Emergency Department for evaluation and treatment. Patients could be activated later by the emergency physician. The primary variables of interest were number of activations after initial “rule out,” injury severity score (ISS) for patients who were activated, mechanism of injury, and disposition.

Results

A total of 1874 TNC screenings were performed. Of these, 1449 (77%) patients did not meet trauma activation criteria. Only 41 (2.8%) patients initially ruled out were later activated by the emergency physician and admitted for treatment of injuries. The average ISS of all activated patients was 9 ± 6. Thirty-six patients had an ISS ≤ 15, four between 16 and 25, and only one patient had an ISS > 25. Twenty-seven patients were admitted to the ward, five went to step-down units, and five required intensive care unit admission. Four patients required operative intervention for their injuries.

Conclusion

These results suggest that nursing screening protocols can be safe, effective tools for triage of trauma patients.

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Fig. 1

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The authors have no relevant financial or non-financial interests to disclose.

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Correspondence to Ryan P. Dumas.

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Gupta, V.S., Burke, K., Bruns, B.R. et al. Utilization of trauma nurse screening procedure for triage of the injured patient. Eur J Trauma Emerg Surg (2022). https://doi.org/10.1007/s00068-022-02105-8

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Keywords

  • Trauma
  • Undertriage
  • Overtriage
  • Screening
  • Standardization