Implementation of a two-tier trauma response

Objective: To apply a triage tool to patients on their arrival in the emerg ency department and determine the efficacy and safety of a two-tier trauma response. Design: Descriptive prospective audit. Setting: Principal urban r eferral hospital that provides a major trauma service. Materials and Method s: The triage tool designated a major trauma or stable trauma response. A m ajor trauma designation mobilised a multidisciplinary team and a stable tra uma designation an expedited evaluation by emergency department staff. Chi- square lest and Mann-Whitney U test were used to compare major and stable t rauma 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 interquarti le 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%, undertriag e rate of 8% and overtriage rate of 10%. Conclusion: The triage tool adequa tely distinguished between patients with and without major trauma. Undertri aged patients had timely and appropriate referral for definitive surgical c are and had no adverse outcomes. (C) 1998 Elsevier Science Ltd. All rights reserved.