Evaluation of outcomes after adoption of a three-tiered trauma triage system

Abstract

INTRODUCTION: Prior to February 2009, patients were either evaluated by the trauma team as activations or as consults. To improve the efficiency of triage, a three-tiered system was introduced in February 2009. The additional triage tier (T3) was aimed at patients at risk for serious injuries but did not meet activation criteria, and required evaluation by a team headed by the emergency department physician. METHODS: All adult patients from two time periods prior to (PreT3, Nov 2007-Jan 2009) and after (postT3, Nov 2010- Jan 2012)the introduction of T3 were compared with respect to systolic blood pressure (SBP), injury severity score (ISS), Glasgow Coma Score (GCS), Injury Severity Score (ISS) and mortality. Patients above 60 years old were similarly compared. RESULTS: There were 2682 PreT3 and 3360 Post T3 patients, with 23% of PostT3 patients evaluated as T3 patients. The proportion of trauma activations declined (62 vs. 74%, p<0.001). PostT3 patients were older (54.1+/-24.9 vs 47.2+/-24.1 years, p<0.001), had similar mean SBP, lower mean GCS (14.2+/- 2.4 vs 14.4+/-2.3, p=0.02), and lower mean ISS (7.5+/-7.8 vs 9.3+/-9.1, p<0.001). Mortality was similar (3.1 vs 3.3%, p=0.6). Among patients above 60 years which comprised 37% of the total sample, PostT3 patients had similar mean GCS, lower SBP (147.8+/-35.1 vs 151.4+/-35.3 mmHg, p<0.001), lower mean ISS (8.0+/-6.8 vs 10.8+/-8.9, p<0.001), and lower mortality (4.6 vs 7.0%, p=0.02) compared to PreT3 patients. CONCLUSIONS: Addition of a new triage level is a viable strategy that can reduce trauma team resource usage and is associated with lower mortality in elderly patients.