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Inappropriate Levels of Trauma Triage and Patient Outcomes FREE TO VIEW

Amy Pate, MD; Krishna Akella; Sraavya Undurty; Samiran Roy Chaudhury; Frederique Pinto, MD; Mina Thomas; Gipanjot Dhillon; Akella Chendrasekhar
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Richmond University Medical Center, Staten Island, NY

Chest. 2015;148(4_MeetingAbstracts):482A. doi:10.1378/chest.2281848
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SESSION TITLE: Process Improvement in Obstructive Lung Disease Education, Pneumonia Readmissions and Rapid Response Systems II

SESSION TYPE: Original Investigation Poster

PRESENTED ON: Wednesday, October 28, 2015 at 01:30 PM - 02:30 PM

PURPOSE: Trauma continues to be a leading cause of morbidity and mortality in the adult population. The objective of this paper is to examine the association between appropriate trauma triage, patient outcomes, and actionable performance improvement (PI) measures.

METHODS: We performed a retrospective chart review of adult patients presenting to an urban level I trauma center after injury from January 2014 to January 2015. Patients were identified using the trauma registry. The appropriateness of activation was scored using the Cribari method as recommended by the current American College of Surgeons guidelines. The presence of actionable PI was determined by medical record review by the institutional trauma director and committee.

RESULTS: A total of 418 patients with a mean age of 44.3 ± 2.4 years were included. 64.4% were male. Mean ISS was 9.3 ± 1.1, mean LOS was 4.7 ± 0.7 days, and mortality was 4.5% (n=19). 55.5% of patients were appropriately triaged, 21.3% were overtriaged, and 23.2% were undertriaged. 23% of cases had actionable PI. There were 10.8% full activations, 27.3% partial activations, and 62% trauma consults. Patients who were undertriaged were older (55.4 ± 4.9 years vs 41.8 ± 4.7 years vs 44.9 ± 3.3 yrs, p<0.001), had higher ISS (14.3 ± 1.2 vs 4.5 ± 0.4 vs 9.1 ± 1.8, p<0.001), and longer LOS (7.2 ± 0.8 vs 2.1 ± 0.5 vs 4.7 ± 1.1 days, p<0.001) compared to those who were overtriaged or appropriately triaged, respectively. Patients who were undertriaged were also less likely to survive to discharge (p<0.002). Undertriage was associated with the presence of actionable PI.

CONCLUSIONS: Inappropriate undertriage of trauma patients is associated with advanced age as well as increased length of stay and reduced survival. The effects of undertriage are likely to become more visibly pronounced as the population continues to age.

CLINICAL IMPLICATIONS: Older patients are often undertriaged in the setting of trauma. Physicians must be cognizant of the significant morbidity and mortality associated with delayed care due to undertriaged activations.

DISCLOSURE: The following authors have nothing to disclose: Amy Pate, Krishna Akella, Sraavya Undurty, Samiran Roy Chaudhury, Frederique Pinto, Mina Thomas, Gipanjot Dhillon, Akella Chendrasekhar

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