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Are there Field Triage Criteria that Can Predict Low-Yield Air Medical Transports?

Published online by Cambridge University Press:  10 October 2019

Hiroko Miyagi ,
David C. Evans  and
Howard A. Werman Open the ORCID record for Howard A. Werman [Opens in a new window]
Hiroko Miyagi
Affiliation:
Department of Urology, University of Florida, Gainesville, Florida USA
David C. Evans
Affiliation:
OhioHealth Mansfield, Mansfield, Ohio USA
Howard A. Werman*
Affiliation:
Department of Emergency Medicine, The Ohio State University, Columbus, Ohio USA
*
Correspondence: Howard A. Werman, MD Department of Emergency Medicine 773 Prior Hall 376 West 10th Avenue Columbus, Ohio 43210 USA E-mail: [email protected]
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Abstract

Introduction:

Air medical transport of trauma patients from the scene of injury plays a critical role in the delivery of severely injured patients to trauma centers. Over-triage of patients to trauma centers reduces the system efficiency and jeopardizes safety of air medical crews.

Hypothesis:

The objective of this study was to determine which triage factors utilized by Emergency Medical Services (EMS) providers are strong predictors of early discharge for trauma patients transported by helicopter to a trauma center.

Methods:

A retrospective chart review over a two-year period was performed for trauma patients flown from the injury site into a Level I trauma center by an air medical transport program. Demographic and clinical data were collected on each patient. Prehospital factors such as Glasgow Coma Score (GCS), Revised Trauma Score (RTS), intubation status, mechanism of injury, anatomic injuries, physiologic parameters, and any combinations of these factors were investigated to determine which triage criteria accurately predicted early discharge. Hospital factors such as Injury Severity Score (ISS), length-of-stay (LOS), survival, and emergency department disposition were also collected. Early discharge was defined as a hospital stay of less than 24 hours in a patient who survives their injuries. A more stringent definition of appropriate triage was defined as a patient with in-hospital death, an ISS >15, those taken to the operating room (OR) or intensive care unit (ICU), or those receiving blood products. Those patients who failed to meet these criteria were also used to determine over-triage rates.

Results:

An overall early discharge rate of 35% was found among the study population. Furthermore, when the more stringent definition was applied, over-triage rates were as high as 85%. Positive predictive values indicated that patients who met at least one anatomic and physiologic criteria were appropriately transported by helicopter as 94% of these patients had stays longer than 24 hours. No other criteria or combination of criteria had a high predictive value for early discharge.

Conclusions:

No individual triage criteria or combination of criteria examined demonstrated the ability to uniformly predict an early discharge. Although helicopter transport and subsequent hospital care is costly and resource consuming, it appears that a significant number of patients will be discharged within 24 hours of their transport to a trauma center. Future studies must determine the impact of eliminating “low-yield” triage criteria on under-triage of scene trauma patients.

Keywords

air medical transporttraumatriage
Type
Original Research
Information
Prehospital and Disaster Medicine , Volume 34 , Issue 6 , December 2019 , pp. 596 - 603
Copyright
© World Association for Disaster and Emergency Medicine 2019 

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References

Centers for Disease Control and Prevention. Ten Leading Causes of Death by Age Group; United States 2017. https://www.cdc.gov/injury/wisqars/pdf/leading_causes_of_death_by_age_group_2017-508.pdf. Accessed July 15, 2015.Google Scholar
Hannay, RS, Wyrzykowski, AD, Ball, CG, Laupland, K, Feliciano, DV. Retrospective review of injury severity, interventions and outcomes among helicopter and non-helicopter transport patients at a Level 1 urban trauma center. Can J Surg. 2014;57(1):49–54.CrossRefGoogle Scholar
Galvagno, SM Jr, Haut, ER, Zafar, SN, et al. Association between helicopter vs ground emergency medical services and survival for adults with major trauma. JAMA. 2012;307(15):1602–1610.Google ScholarPubMed
Stewart, KE, Cowan, LD, Thompson, DM, Sacra, JC, Albrecht, R. Association of direct helicopter versus ground transport and in-hospital mortality in trauma patients: a propensity score analysis. Acad Emerg Med. 2011;18(11):1208–1216.CrossRefGoogle ScholarPubMed
Branas, CC, MacKenzie, EJ, Williams, JC, et al. Access to trauma centers in the United States. JAMA. 2005;293(21):2626–2633.CrossRefGoogle ScholarPubMed
Sasser, S. Guidelines for Field Triage of Injured Patients: Recommendations of the National Expert Panel on Field Triage, 2011. Atlanta, Georgia USA: Center for Disease Control and Prevention 61.1; 2012.Google Scholar
Economic and Planning Systems. An economic analysis of the US rotary wing air medical transport industry. http://medevacfoundation.org/wp-content/uploads/2014/08/Rotary-Wing-AMT-Economic-Benefit-Study-EPS-082114.pdf. Accessed December 30, 2018.Google Scholar
Bledsoe, BE, Smith, MG. Medical helicopter accidents in the United States: a 10-year review. J Trauma. 2004;56(6):1325–1329.CrossRefGoogle ScholarPubMed
Bledsoe, BE, Wesley, AK, Eckstein, M, Dunn, TM, O’Keefe, MF. Helicopter scene transport of trauma patients with nonlife-threatening injuries: a meta-analysis. J Trauma. 2006;60(6):1257–1265.CrossRefGoogle ScholarPubMed
Delgado, MK, Staudenmayer, KL, Wang, NE, et al. Cost-effectiveness of helicopter versus ground emergency medical services for trauma scene transport in the United States. Ann Emerg Med. 2013;62(4):351–364.CrossRefGoogle ScholarPubMed
Madiraju, SK, Catino, J, Korkaram, C, Genuit, T, Bukur, M. In by helicopter out by cab: the financial cost of aeromedical over-triage of trauma patients. J Surg Res. 2017;218:261–270.CrossRefGoogle Scholar
Worster, A, Bledsoe, RD, Cleve, P, Fernandes, CM, Upadhye, S, Eva, K. Reassessing the methods of medical record review studies in emergency medicine research. Ann Emerg Med. 2005;45(4):448–451.CrossRefGoogle ScholarPubMed
Champion, HR, Sacco, WJ, Copes, WS, Gann, DS, Gennarelli, TA, Flanagan, ME. A revision of the Trauma Score. J Trauma. 1989;29(5):623–629.CrossRefGoogle ScholarPubMed
Baxt, WG, Moody, P. The impact of rotorcraft aeromedical emergency care services on trauma mortality. JAMA. 1983; 249(22):3047–3051.CrossRefGoogle ScholarPubMed
Thomas, SH, Harrison, TH, Buras, WR, et al. Helicopter transport and blunt trauma mortality: a multicenter trial. J Trauma. 2002;52(1):136–145.Google ScholarPubMed
Frankema, SPG, Ringburg, AN, Steyerberg, EW, Edwards, MJR, Schipper, IB, van Vugt, AB. Beneficial effect of helicopter emergency medical services on survival of severely injured patients. Br J Surg. 2004;91(11):1520–1526.CrossRefGoogle ScholarPubMed
McVey, J, Petrie, DA, Tallon, JM. Air versus ground transport of the major trauma patient: a natural experiment. Prehosp Emerg Care. 2010;14(1):45–50.CrossRefGoogle ScholarPubMed
Brown, JB, Stassen, NA, Bankey, PE, Sangosanya, AT, Cheng, JD, Gestring, ML. Helicopters and the civilian trauma system: national utilization patterns demonstrate improved outcomes after traumatic injury. J Trauma. 2010;69(5):1030–1036.CrossRefGoogle ScholarPubMed
Newgard, CD, Staudenmayer, K, Hsia, RY, et al. The cost of over-triage: more than one-third of low-risk injured patients were taken to major trauma centers. Health Aff (Millwood). 2013;32(9):1591–1599.CrossRefGoogle Scholar
DeKeyser, FG, Paratore, A, Seneca, RP, Trask, A. Decreasing the cost of trauma care: a system of secondary in hospital triage. Ann Emerg Med. 1994;23(4):841–844.CrossRefGoogle Scholar
Cook, CH, Muscarella, P, Praba, AC, Melvin, W, Martin, LC. Reducing over-triage without compromising outcomes in trauma patients. Arch Surg. 2001;136(7):752–756.CrossRefGoogle Scholar
Uleberg, O, Vinjevoll, OP, Eriksson, U, et al. Over-triage in trauma: what are the causes? Acta Anaesthesiol Scand. 2007;51(9):1178–1183.Google Scholar
Shawhan, RR, McVay, DP, Casey, L, Spears, T, Steele, SR, Martin, MJ. A simplified trauma triage system safely reduces over-triage and improves provider satisfaction: a prospective study. Am J Surg. 2015;209(5):856–862.CrossRefGoogle Scholar
O’Rourke, B, Bade, RH, Drezner, T. Trauma triage: a nine-year experience. Ann Emerg Med. 1992;21(6):680–687.CrossRefGoogle ScholarPubMed
Michailidou, M, Goldstein, SD, Salazar, J, et al. Helicopter over-triage in pediatric trauma. J Pediatr Surg. 2014;49(11):1673–1677.CrossRefGoogle Scholar
Lehmann, R, Brounts, L, Lesperance, K, et al. A simplified set of trauma triage criteria to safely reduce over-triage: a prospective study. Arch Surg. 2009;144(9):853–858.CrossRefGoogle Scholar
Lecky, FE, Omar, M, Bouamra, O, et al. The effect of preinjury warfarin use on mortality rates in trauma patients: a European multicenter study. Emerg Med J. 2015;32(12):916–920.CrossRefGoogle Scholar
Bonville, DJ, Ata, A, Jahraus, CB, et al. Impact of preinjury warfarin and antiplatelet agents on outcomes of trauma patients. Surgery. 2011;150(4):861–868.CrossRefGoogle ScholarPubMed
Nishijima, DK, Shahlaie, K, Sarkar, K, Rudisill, N, Holmes, JF. Risk of unfavorable long-term outcome in older adults with traumatic intracranial hemorrhage and anticoagulant or antiplatelet use. Am J Emerg Med. 2013;31(8):1244–1247.CrossRefGoogle ScholarPubMed
Tollefsen, MH, Vik, A, Skandsen, T, et al. Patients with moderate and severe traumatic brain injury: impact of preinjury platelet inhibitor or warfarin treatment. World Neurosurg. 2018;114:e209–e217.CrossRefGoogle ScholarPubMed
Fries, GR, McCalla, G, Levitt, MA, Cordova, R. A prospective comparison of paramedic judgment and the trauma triage rule in the prehospital setting. Ann Emerg Med. 1994;24(5):885–889.CrossRefGoogle ScholarPubMed
Mulholland, SA, Cameron, PA, Gabbe, BJ, et al. Prehospital prediction of the severity of blunt anatomic injury. J Trauma. 2008;64(3):754–760.CrossRefGoogle ScholarPubMed
Qazi, K, Kempf, JA, Christopher, NC, Gerson, LW. Paramedic judgment of the need for trauma team activation for pediatric patients. Acad Emerg Med. 1998;5(10):1002–1007.CrossRefGoogle ScholarPubMed
Brown, JB, Gestring, ML, Guyette, FX, et al. Development and validation of the Air Medical Prehospital Triage score for helicopter transport of trauma patients. Ann Surg. 2016;264(2):378–385.CrossRefGoogle ScholarPubMed
Brown, JB, Gestring, ML, Guyette, FX, et al. External validation of the Air Medical Prehospital Triage score for identifying trauma patients likely to benefit from scene helicopter transport. J Trauma Acute Care Surg. 2017;82(2):270–279.CrossRefGoogle ScholarPubMed