EVIDENCE FOR AND IMPACT OF SELECTIVE REPORTING OF TRAUMA TRIAGE MECHANISM CRITERIA

Objective: To determine whether out-of-hospital care charts selectivel y report trauma triage criteria, and the impact of such documentation on triage guideline development. Methods: A special structured data in strument that requested the presence or absence of the American Colleg e of Surgeons (ACS) trauma triage criteria was completed by emergency medical services (EMS) personnel transporting victims of motor vehicle crashes. The standard written EMS report forms for a subset of 199 pa tients with at least 1 ACS trauma triage mechanism criterion were revi ewed by the investigators. Outcome data were obtained from medical rec ord review. The structured data instrument and the standard EMS report were compared for concordance, The impact of method of data collectio n on the ability of the ACS criteria to predict patient outcome was de termined. Results: EMS reports and structured data instruments similar ly noted the presence of anatomic, physiologic, and ''other'' trauma t riage criteria (p>0.07 for all individual comparisons). Most mechanism -of-injury criteria noted on the data instrument (pedestrian struck >2 0 mph; crash speed >20 mph; vehicle deformity; compartment intrusion; rollover; and ejection) were infrequently documented on the standard E MS report (median 28.5% noted, range 0-100%), Patients who had mechani sm criteria noted on the EMS report were more likely to be admitted to the hospital (44% vs 13%; p = 0.006), to require major operative proc edures (10% vs 0%; p = 0.005), and to have prolonged lengths of stay ( 26% vs 9%; p = 0.02) and injury severity scores greater than or equal to 16 (15% vs 3%; p = 0.03) than were patients who had mechanism crite ria documented only on the structured data instrument. Conclusions: In the authors' EMS system, standard EMS report documentation underrepor ts ACS trauma triage mechanism criteria. This underreporting appears t o bias outcome analysis in the direction of a worse outcome and more r esource utilization. Reporting of mechanism-of-injury criteria improve s with use of a structured data instrument.