Triage of Injured Patients in New York State Prior to Implementation of the American College of Surgeons Committee on Trauma Verification System

Abstract

Trauma center (TC) care reduces mortality for injured patients, but non-trauma centers (NTCs) treat more than a third of severely injured patients. In 2012, New York State (NYS) adopted the American College of Surgeons Committee on Trauma (ACS-COT) system of TC verification. We hypothesized that before this change, NYS had a lower undertriage rate than states already using the ACS-COT system. We identified all NYS residents presenting for injury in 2011 using the State Emergency Department and Inpatient Databases. We used injury severity score (ISS) ≥ 15 to indicate those likely to benefit from TC care. Multivariable logistic regression to identified predictors of TC presentation. We used coarsened exact matching (CEM) to compare NYS to New Jersey (NJ) and Massachusetts (MA), which had ACS-COT verified TCs. Of 14,788 patients with ISS > 15, 59.5 presented to a TC (57.3% for ISS 16-24 and 77.0% for ISS ≥25). In multivariable logistic regression, each mile of increased distance to a TC was associated with 3% lower odds of TC presentation. Older age, female sex, and residence in a low-income area were associated with undertriage. Chest injuries had the highest odds of TC presentation (odds ratio [OR] 3.7, 95% CI 3.0-4.5), while falls had the lowest (OR 0.4, 95% CI 0.3-0.4). After CEM, odds of TC presentation in NYS were equivalent to NJ and MA. Prior to adoption of ACS-COT system, 2 in 5 severely injured NYS patients were treated at NTCs, equivalent to comparison states. Ongoing system improvement should balance rigorous TC designation standards, maximizing patient access, and optimizing triage.