Effectiveness of a 2-Specialty, 2-Tiered Triage and Trauma Team Activation Protocol, ,

Study Objective: To determine the effectiveness, safety, and resource allocation of a 2-specialty, 2-tiered triage and trauma team activation protocol. Methods: We conducted a 6-month retrospective analysis of a 2-specialty, 2-tiered trauma team activation system at an urban Level I trauma center. Based on prehospital data, patients with a high likelihood of serious injury were assigned to triage category 1 and patients with a low likelihood of serious injury were assigned to category 2. Category 1 patients were immediately evaluated by both emergency medicine and trauma services. Category 2 patients were evaluated initially by emergency medicine staff with a mandatory trauma service consultation. Main outcomes measured included mortality, need for emergency procedures, need for emergency surgery, complications, and discharge disposition. Potential physician-hours saved were calculated for category 2 cases. Results: Five hundred sixty-one patients were assigned a triage classification (272 to category I and 289 to category 2). Category 1 patients had a higher mortality rate (95% confidence interval [CI] for difference of 15.9%, 11.1% to 20.7%, P<.0001), need for emergency surgery (10.7% versus 1.4%, 95% CI for difference of 9.3%, 5.2% to 13.4%; P<.0001), need for emergency procedures (89% of total procedures, 95% CI 83% to 95%; P<.0001), and discharges to rehabilitation facilities (95% CI for difference of 15.1%, 9.3% to 21.0%; P<.0001). The 2-tiered response system saved an estimated 578 physician-hours of time for the trauma service over the study period. Conclusion: This evaluation tool effectively predicts likelihood of serious injury, mortality, need for emergency surgery, and need for rehabilitation. Patients with a low likelihood of serious injury may be initially evaluated by the emergency medicine service effectively and safely, thus allowing more efficient use of surgical personnel.[Plaisier BR, Meldon SW, Super DM, Jouriles NJ, Barnoski AL, Fallon WF Jr, Malagnoni MA: Effectiveness of a 2-specialty, 2-tiered triage and trauma team activation protocol. Ann Emerg Med October 1998;32:436-441.]