World Journal of Surgery

, Volume 42, Issue 5, pp 1321–1326 | Cite as

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 A. Schreiber
Original Scientific Report



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).


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.


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%.


Tachypnea with suspected thoracic injury is the strongest level 2 triage modification to reduce level 3 under-triage.


Compliance with ethical standards

Conflict of interest

The authors have no conflicts of interest.


  1. 1.
    Sasser SM, Hunt RC, Faul M et al (2012) Guidelines for field triage of injured patients: recommendations of the National Expert Panel on Field Triage, 2011. MMWR Recomm Rep 61(1):1–20PubMedGoogle Scholar
  2. 2.
    Rotondo MM, Cribari CM, Smith SM (2014) Resources for optimal care of the injured patient. Comm Trauma Am Coll Surg 1:1Google Scholar
  3. 3.
    Cohen R, Adini B, Radomislensky I, Givon A, Rivkind AI, Peleg K (2012) Involvement of surgical residents in the management of trauma patients in the emergency room: does the presence of an attending physician affect outcomes? World J Surg 36(3):539–547. CrossRefPubMedGoogle Scholar
  4. 4.
    Cox JA, Bernard AC, Bottiggi AJ et al (2014) Influence of in-house attending presence on trauma outcomes and hospital efficiency. J Am Coll Surg 218(4):734–738. CrossRefPubMedGoogle Scholar
  5. 5.
    Durham R, Shapiro D, Flint L (2005) In-house trauma attendings: is there a difference? Am J Surg 190(6):960–966. CrossRefPubMedGoogle Scholar
  6. 6.
    Helling TS, Nelson PW, Shook JW, Lainhart K, Kintigh D (2003) The presence of in-house attending trauma surgeons does not improve management or outcome of critically injured patients. J Trauma 55(1):20–25. CrossRefPubMedGoogle Scholar
  7. 7.
    Mains C, Scarborough K, Bar-Or R et al (2009) Staff commitment to trauma care improves mortality and length of stay at a level I trauma center. J Trauma 66(5):1315–1320. CrossRefPubMedGoogle Scholar
  8. 8.
    Porter JM, Ursic C (2001) Trauma attending in the resuscitation room: does it affect outcome? Am Surg 67(7):611–614PubMedGoogle Scholar
  9. 9.
    Tinkoff GH, O’Connor RE (2002) Validation of new trauma triage rules for trauma attending response to the emergency department. J Trauma 52(6):1153–1158 (discussion 1158–1159) CrossRefPubMedGoogle Scholar
  10. 10.
    Lehmann R, Brounts L, Lesperance K et al (2009) A simplified set of trauma triage criteria to safely reduce overtriage: a prospective study. Arch Surg 144(9):853–858. CrossRefPubMedGoogle Scholar

Copyright information

© Société Internationale de Chirurgie 2017

Authors and Affiliations

  1. 1.Division of Trauma, Critical Care, and Acute Care Surgery, Department of SurgeryOregon Health and Science UniversityPortlandUSA

Personalised recommendations