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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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