Background
Over-triage not only wastes resources but displaces the patient from their community and causes delay of treatment for the more seriously injured. This study aimed to validate the Random Forest computer model (RFM) as means of better triaging trauma patients to Level I trauma centers.
Methods
Adult trauma patients with “medium activation” presenting via helicopter to a Level I Trauma Center from May 2007 to May 2009 were included. The “medium activation” trauma patient is alert and hemodynamically stable on scene but has either subnormal vital signs or an accumulation of risk factors that may indicate a potentially serious injury. Variables included in the RFM computer analysis including demographics, mechanism of injury, pre-hospital fluid, medications, vitals, and disposition.
Statistical analysis was performed via the Random Forest Algorithm to compare our institutional triage rate to rates determined by the RFM.
Results
A total of 1,653 patients were included in this study of which 496 were used in the testing set of the RFM. In our testing set, 33.8% of patients brought to our Level I trauma center could have been managed at a Level III trauma center and 88% of patients that required a Level I trauma center were identified correctly. In the testing set, there was an over-triage rate of 66% while utilizing the RFM we decreased the over-triage rate to 42% (p<0.001). There was an under-triage rate of 8.3%.
The RFM predicted patient disposition with a sensitivity of 89%, specificity of 42%, negative predictive value of 92% and positive predictive value of 34%.
Conclusion
While prospective validation is required, it appears that computer modeling potentially could be used to guide triage decisions, allowing both more accurate triage and more efficient use of the trauma system.