Implementation of a two-tier trauma response

Abstract

Objective: To apply a triage tool to patients on their arrival in the emergency department and determine the efficacy and safety of a two-tier trauma response. Design: Descriptive prospective audit. Setting: Principal urban referral hospital that provides a major trauma service. Materials and methods: The triage tool designated a major trauma or stable trauma response. A major trauma designation mobilised a multidisciplinary team and a stable trauma designation an expedited evaluation by emergency department staff. Chi-square test and Mann–Whitney U test were used to compare major and stable trauma designations. Triage accuracy was evaluated using outcome variables. Main results: 78% of 58 major trauma responses and 30% of 180 stable trauma responses were admitted. The median injury severity score (and interquartile range) of admitted patients was 9.0 (5.0–19.5) for major responses and 5.0 (2.0–9.0) for stable responses. The triage tool had a sensitivity of 65%, specificity of 87%, accuracy (appropriate triage rate) of 82%, undertriage rate of 8% and overtriage rate of 10%. Conclusion: The triage tool adequately distinguished between patients with and without major trauma. Undertriaged patients had timely and appropriate referral for definitive surgical care and had no adverse outcomes.