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Undertriage of Trauma-Related Deaths in U.S. Emergency Departments
INTRODUCTION: Accurate field triage of critically injured patients to trauma centers is vital for improving survival. We sought to estimate the national degree of undertriage of trauma patients who die in emergency departments (EDs) by evaluating the frequency and characteristics associated with tri...
Autores principales: | , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
Department of Emergency Medicine, University of California, Irvine School of Medicine
2016
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4899063/ https://www.ncbi.nlm.nih.gov/pubmed/27330664 http://dx.doi.org/10.5811/westjem.2016.2.29327 |
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author | Holst, Jenelle A. Perman, Sarah M. Capp, Roberta Haukoos, Jason S. Ginde, Adit A. |
author_facet | Holst, Jenelle A. Perman, Sarah M. Capp, Roberta Haukoos, Jason S. Ginde, Adit A. |
author_sort | Holst, Jenelle A. |
collection | PubMed |
description | INTRODUCTION: Accurate field triage of critically injured patients to trauma centers is vital for improving survival. We sought to estimate the national degree of undertriage of trauma patients who die in emergency departments (EDs) by evaluating the frequency and characteristics associated with triage to non-trauma centers. METHODS: This was a retrospective cross-sectional analysis of adult ED trauma deaths in the 2010 National Emergency Department Sample (NEDS). The primary outcome was appropriate triage to a trauma center (Level I, II or III) or undertriage to a non-trauma center. We subsequently focused on urban areas given improved access to trauma centers. We evaluated the associations of patient demographics, hospital region and mechanism of injury with triage to a trauma versus non-trauma center using multivariable logistic regression. RESULTS: We analyzed 3,971 included visits, representing 18,464 adult ED trauma-related deaths nationally. Of all trauma deaths, nearly half (44.5%, 95% CI [43.0–46.0]) of patients were triaged to non-trauma centers. In a subgroup analysis, over a third of urban ED visits (35.6%, 95% CI [34.1–37.1]) and most rural ED visits (86.4%, 95% CI [81.5–90.1]) were triaged to non-trauma centers. In urban EDs, female patients were less likely to be triaged to trauma centers versus non-trauma centers (adjusted odds ratio [OR] 0.83, 95% CI [0.70–0.99]). Highest median household income zip codes (≥$67,000) were less likely to be triaged to trauma centers than lowest median income ($1–40,999) (OR 0.54, 95% CI [0.43–0.69]). Compared to motor vehicle trauma, firearm trauma had similar odds of being triaged to a trauma center (OR 0.90, 95% CI [0.71–1.14]); however, falls were less likely to be triaged to a trauma center (OR 0.50, 95 %CI [0.38–0.66]). CONCLUSION: We found that nearly half of all trauma patients nationally and one-third of urban trauma patients, who died in the ED, were triaged to non-trauma centers, and thus undertriaged. Sex and other demographic disparities associated with this triage decision represent targeted opportunities to improve our trauma systems and reduce undertriage. |
format | Online Article Text |
id | pubmed-4899063 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2016 |
publisher | Department of Emergency Medicine, University of California, Irvine School of Medicine |
record_format | MEDLINE/PubMed |
spelling | pubmed-48990632016-06-17 Undertriage of Trauma-Related Deaths in U.S. Emergency Departments Holst, Jenelle A. Perman, Sarah M. Capp, Roberta Haukoos, Jason S. Ginde, Adit A. West J Emerg Med Health Outcomes INTRODUCTION: Accurate field triage of critically injured patients to trauma centers is vital for improving survival. We sought to estimate the national degree of undertriage of trauma patients who die in emergency departments (EDs) by evaluating the frequency and characteristics associated with triage to non-trauma centers. METHODS: This was a retrospective cross-sectional analysis of adult ED trauma deaths in the 2010 National Emergency Department Sample (NEDS). The primary outcome was appropriate triage to a trauma center (Level I, II or III) or undertriage to a non-trauma center. We subsequently focused on urban areas given improved access to trauma centers. We evaluated the associations of patient demographics, hospital region and mechanism of injury with triage to a trauma versus non-trauma center using multivariable logistic regression. RESULTS: We analyzed 3,971 included visits, representing 18,464 adult ED trauma-related deaths nationally. Of all trauma deaths, nearly half (44.5%, 95% CI [43.0–46.0]) of patients were triaged to non-trauma centers. In a subgroup analysis, over a third of urban ED visits (35.6%, 95% CI [34.1–37.1]) and most rural ED visits (86.4%, 95% CI [81.5–90.1]) were triaged to non-trauma centers. In urban EDs, female patients were less likely to be triaged to trauma centers versus non-trauma centers (adjusted odds ratio [OR] 0.83, 95% CI [0.70–0.99]). Highest median household income zip codes (≥$67,000) were less likely to be triaged to trauma centers than lowest median income ($1–40,999) (OR 0.54, 95% CI [0.43–0.69]). Compared to motor vehicle trauma, firearm trauma had similar odds of being triaged to a trauma center (OR 0.90, 95% CI [0.71–1.14]); however, falls were less likely to be triaged to a trauma center (OR 0.50, 95 %CI [0.38–0.66]). CONCLUSION: We found that nearly half of all trauma patients nationally and one-third of urban trauma patients, who died in the ED, were triaged to non-trauma centers, and thus undertriaged. Sex and other demographic disparities associated with this triage decision represent targeted opportunities to improve our trauma systems and reduce undertriage. Department of Emergency Medicine, University of California, Irvine School of Medicine 2016-05 2016-05-02 /pmc/articles/PMC4899063/ /pubmed/27330664 http://dx.doi.org/10.5811/westjem.2016.2.29327 Text en © 2016 Holst et al. http://creativecommons.org/licenses/by/4.0/ This is an open access article distributed in accordance with the terms of the Creative Commons Attribution (CC BY 4.0) License. See: http://creativecommons.org/licenses/by/4.0/ |
spellingShingle | Health Outcomes Holst, Jenelle A. Perman, Sarah M. Capp, Roberta Haukoos, Jason S. Ginde, Adit A. Undertriage of Trauma-Related Deaths in U.S. Emergency Departments |
title | Undertriage of Trauma-Related Deaths in U.S. Emergency Departments |
title_full | Undertriage of Trauma-Related Deaths in U.S. Emergency Departments |
title_fullStr | Undertriage of Trauma-Related Deaths in U.S. Emergency Departments |
title_full_unstemmed | Undertriage of Trauma-Related Deaths in U.S. Emergency Departments |
title_short | Undertriage of Trauma-Related Deaths in U.S. Emergency Departments |
title_sort | undertriage of trauma-related deaths in u.s. emergency departments |
topic | Health Outcomes |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4899063/ https://www.ncbi.nlm.nih.gov/pubmed/27330664 http://dx.doi.org/10.5811/westjem.2016.2.29327 |
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