Emergency physician and nurse discretion accurately triage high-risk trauma patients

Schellenberg, Morgan; Docherty, Stephen; Owattanapanich, Natthida; Emigh, Brent; Lutterman, Paige; Karavites, Lindsey; Switzer, Emily; Wiepking, Matthew; Chudnofsky, Carl R.; Inaba, Kenji

doi:10.1007/s00068-022-02056-0

Cited by 2 publications

(3 citation statements)

References 12 publications

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“…Severely undertriaged patients had higher initial systolic blood pressure in the field (137 [118-150] vs 116 [88-143] mmHg, P < .001) and in the ED (131 [116-149] vs 123 [76-148] mmHg, P < .001). Glasgow Coma Scale was also higher among SU patients (in the field, 15 [14][15] vs 6 [3][4][5][6][7][8][9][10][11][12][13][14], P < .001 and in the ED, 15 [14][15] vs 6 [3][4][5][6][7][8][9][10][11][12][13][14], P < .001). Severely undertriaged patients had a lower median ISS than AT patients (29 [26-30] vs 32 [27-41], P < .001).…”

Section: Resultsmentioning

confidence: 87%

“…The standard ACS COT TTA criteria 1 are systolic blood pressure <90 mmHg; gunshot wound to the neck, torso, or extremities proximal to the elbow and knee; Glasgow Coma Scale (GCS) score <9; patients with respiratory compromise, including those intubated on scene; transferred patients who are receiving blood products; and any trauma patient deemed to potentially benefit from prehospital TTA as determined by the Emergency Medicine provider's discretion. 3 At our institution, we use a modified set of TTA criteria (mTTA) in which age over 70 years with traumatic mechanism other than ground level falls is added to the ACS COT TTA criteria. This is a result of previous work demonstrating an increased risk of morbidity and mortality among older adult trauma patients.…”

Section: Methodsmentioning

confidence: 99%

“…When patients with major trauma, defined as an Injury Severity Score (ISS) > 15, do not meet TTA criteria, they are termed undertriaged and are at risk for adverse outcomes and mortality. 2,3 It is unclear what impact undertriage has on severely injured patients (ISS ≥25) who evade current TTA criteria. These patients are termed the severely undertriaged (SU) and theoretically are at further risk for adverse outcomes due to the magnitude of their traumatic injuries.…”

Section: Introductionmentioning

confidence: 99%

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Undertriage of Severely Injured Trauma Patients

Anderson

Schellenberg

Owattanapanich

et al. 2023

The American Surgeon™

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Introduction The American College of Surgeons (ACS) delineates trauma team activation (TTA) criteria to identify seriously injured trauma patients in the field. Patients are deemed to be severely undertriaged (SU), placing them at risk for adverse outcomes, when they do not meet TTA criteria but nonetheless sustain significant injuries (Injury Severity Score [ISS] ≥25). Objectives Delineate patient demographics, injuries, and outcomes after SU. Participants Trauma patients presenting to our ACS-verified Level 1 trauma center with ISS ≥25 were included (11/2015-03/2022). Transfers and private vehicle transports were excluded. Patients were dichotomized and compared by trauma arrival level: TTA (Appropriately Triaged, AT) vs routine consults (SU). Results Study criteria were satisfied by 1653 patients: 1375 (83%) AT and 278 (17%) SU. Severely undertriaged patients were older than AT patients (47 vs 36 years, P < .001). Severely undertriaged occurred almost exclusively following blunt trauma (96% vs 71%, P < .001). Injury Severity Score was lower following SU than AT (29 vs 32, P < .001). The most common severe injuries (Abbreviated Injury Scale score [AIS] ≥3) among the SU group were in the Chest (n = 179, 64%). Severely undertriaged patients necessitated emergent intubation (n = 34, 12%), surgery (n = 59, 21%), and angioembolization (n = 22, 8%) at high rates. Severely undertriaged mortality was n = 40, 14%. Conclusion Severely undertriaged occurred among a substantial proportion of ISS ≥25 patients, predominately following blunt trauma. Severe chest injuries were most likely to evade capture. Rates of intubation, emergent intervention, and in-hospital mortality were high after SU. Efforts should be made to identify such patients in the field as they may benefit from TTA.

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Section: Resultsmentioning

confidence: 87%

Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Undertriage of Severely Injured Trauma Patients

Anderson

Schellenberg

Owattanapanich

et al. 2023

The American Surgeon™

Self Cite

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An Evaluation on the Potential of Large Language Models for Use in Trauma Triage

Le,

Chen,

Mai

et al. 2024

Emergency Care and Medicine

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Large Language Models (LLMs) are becoming increasingly adopted in various industries worldwide. In particular, there is emerging research assessing the reliability of LLMs, such as ChatGPT, in performing triaging decisions in emergent settings. A unique aspect of emergency triaging is the process of trauma triaging. This process requires judicious consideration of mechanism of injury, severity of injury, patient stability, logistics of location and type of transport in order to ensure trauma patients have access to appropriate and timely trauma care. Current issues of overtriage and undertriage highlight the potential for the use of LLMs as a complementary tool to assist in more accurate triaging of the trauma patient. Despite this, there remains a gap in the literature surrounding the utility of LLMs in the trauma triaging process. This narrative review explores the current evidence for the potential for implementation of LLMs in trauma triaging. Overall, the literature highlights multifaceted applications of LLMs, especially in emergency trauma settings, albeit with clear limitations and ethical considerations, such as artificial hallucinations, biased outputs and data privacy issues. There remains room for more rigorous research into refining the consistency and capabilities of LLMs, ensuring their effective integration in real-world trauma triaging to improve patient outcomes and resource utilisation.

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Emergency physician and nurse discretion accurately triage high-risk trauma patients

Cited by 2 publications

References 12 publications

Undertriage of Severely Injured Trauma Patients

Undertriage of Severely Injured Trauma Patients

An Evaluation on the Potential of Large Language Models for Use in Trauma Triage

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