EVALUATION OF AMERICAN-COLLEGE OF SURGEONS TRAUMA TRIAGE CRITERIA IN A SUBURBAN AND RURAL SETTING

In suburban and rural counties, patient transport to specialized facil ities such as trauma centers may result in prolonged transport times w ith the resultant loss of ambulance coverage in the primary service ar ea. We evaluated the American College of Surgeons trauma triage criter ia as modified by New York State to determine the ability of these cri teria to predict the need for trauma center care in victims of blunt t raumatic injury, Blunt trauma patients were retrospectively identified through review of patient care reports for the presence either of mec hanism or of physiological criteria for transport to a trauma center, Controls were randomly selected from patients with blunt trauma not me eting any of the criteria, Main outcome parameters were the emergency department (ED) disposition, length of hospital stay, need for intensi ve care unit (ICU) care, and major nonorthopedic operative interventio ns. There were 857 patients enrolled, The presence either of mechanism or of physiological criteria increased the likelihood of hospital adm ission (control, 11%; mechanism, 35%; and physiological, 33%), Relativ e to patients without any criteria, the presence of mechanism criteria alone did not identify patients who required a prolonged length of st ay (67% vs 71%), intensive care unit services (13% vs 19%) or major no northopedic operative interventions (0.2% vs 1.6%). The presence of ph ysiological criteria increased the likelihood of requiring all of thes e services. These comparisons held true for victims of motor vehicle a ccidents, pedestrians struck by motor vehicles, and people who fell fr om heights above ground level Patients with physiologic criteria may b enefit from transport directly to a trauma center, Because of the low need for operative intervention and ICU services, patients with no cri teria or mechanism criteria at long distances from a trauma center may be initially evaluated at the closest hospital and transferred to a t rauma center if hospitalization or ICU care is necessary, Further stud y to determine the predictive value of certain individual mechanism cr iteria is warranted. (Copyright (C) 1995 by W.B. Saunders Company)