Establishing the Need for Trauma Center Care: Anatomic Injury or Resource Use?

Abstract

Objective. It remains unclear whether the “need” for care at a trauma center should be based on anatomic injury (the current standard) or specialized resource use. We investigated whether anatomic injury severity scores adequately explain hospital resource use. Methods. This was a retrospective cohort study including children andadults meeting statewide trauma criteria andtransported to 48 hospitals from 1998 to 2003. The injury severity score (ISS) was considered as both continuous (range 0–75) andcategorical (0–8, 9–15, and≥ 16) terms. Specialized resource use was defined as: major surgery (with andwithout orthopedic intervention), mechanical ventilation > 96 hours, blood transfusion, intensive care unit (ICU) stay ≥ 2 days, or in-hospital mortality. Resource use was assessed as both a binary variable anda continuous term. Descriptive statistics andsimple andmultivariable linear regressions were used to compare ISS andresource use. Results. 33,699 injured persons were included in the analysis. Within mild, moderate, andserious anatomic injury categories, 8%, 26%, and69%, respectively, had specialized resource use. When the resource use definition included orthopedic surgery, 12%, 49%, and76%, respectively, had specialized resource use. Whereas there was fair correlation between ISS andadditive resource use (rho = 0.61), ISS explained only 37% of the variability in resource use (adjusted R-squared = 0.37). Resource use within anatomic injury categories differed by age group. Conclusions. The standard anatomic injury criterion for trauma center “need” (i.e., ISS ≥ 16) misclassifies a substantial number of injured persons requiring critical trauma resources. Out-of-hospital trauma triage guidelines based on anatomic injury may need revision to account for patients with resource need.