Triage Protocol: Both Undertriage and Overtriage Need to Be Evaluated

Raynaud, Laurent; Borne, Marc; Coste, Sébastien; Daban, Jean-Louis; Tourtier, J.-P.

doi:10.1097/ta.0b013e3181ec4e1d

Cited by 45 publications

(8 citation statements)

References 2 publications

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“…59,60 Overall, triage protocols and their effects on undertriage and overtriage must be evaluated for all age ranges to study the effects on the primary patient as well as other patients within the hospital and system that account for appropriate resource utilization. 61–63 …”

Section: Commentmentioning

confidence: 99%

Factors Associated With Trauma Center Use for Elderly Patients With Trauma

Hsia¹

2011

Arch Surg

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Objectives To estimate the likelihood of trauma center admission for injured elderly patients with trauma, determine trends in trauma center admissions, and identify factors associated with trauma center use for elderly patients with trauma. Design Retrospective analysis. Setting Acute care hospitals in California. Patients All patients hospitalized for acute traumatic injuries during the period from January 1, 1999, to December 31, 2008 (n=430 081). Patients who had scheduled admissions for nonacute or minor trauma were excluded. Main Outcome Measure Likelihood of admission to level I or II trauma center was calculated according to age categories after adjusting for patient and system factors. Results Of 430 081 patients admitted to California acute care hospitals for trauma-related diagnoses, 27% were older than 65 years. After adjusting for demographic, clinical, and system factors, compared with trauma patients aged 18–25 years, the odds of admission to a trauma center decreased with increasing age; patients aged 26–45 years had lower odds (odds ratio [OR], 0.75; 95% confidence interval [CI], 0.71–0.80) of being admitted to a trauma center for their injuries than did patients 46–65 years of age (OR, 0.57; 95% CI, 0.54–0.60), patients 66–85 years of age (OR, 0.35; 95% CI, 0.30–0.41), and patients older than 85 years (OR, 0.30; 95% CI, 0.25–0.36). Similar patterns were found when stratifying the analysis by trauma type and severity. Living more than 50 miles away from a trauma center (OR, 0.03; 95% CI, 0.01–0.06) and lack of county trauma center (OR, 0.17; 95% CI, 0.09–0.35) were also predictors of not receiving trauma care. Conclusion Age and likelihood of admission to a trauma center for injured patients were observed to be inversely proportional after controlling for other factors. System-level factors play a major role in determining which injured patients receive trauma care.

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Section: Commentmentioning

confidence: 99%

Factors Associated With Trauma Center Use for Elderly Patients With Trauma

Hsia¹

2011

Arch Surg

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“…Among these, the most widely discussed and feared is undertriage, which can result in patient morbidity and mortality because of delayed or missed interventions. 2,4 For this reason, most triage systems have focused on minimizing undertriage rates as much as possible without regard to the impact on overtriage or mistriage. The result has been an acceptance of overtriage rates well above 50% as a ''necessary evil'' of avoiding undertriage and missed significant injuries.…”

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confidence: 99%

A simplified trauma triage system safely reduces overtriage and improves provider satisfaction: a prospective study

Shawhan

McVay

Casey

et al. 2015

The American Journal of Surgery

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“…This has been carried out by frequent reminders for OER staff on prioritizing urgent conditions and encouraging the OER doctor to spend the least possible time with the patients inside the exam room to facilitate seeing more patients. 15 …”

Section: Discussionmentioning

confidence: 99%

Triaging self-referred patients attending ophthalmic emergency room

Alsamnan

Mousa

Al-Kuwaileet

et al. 2015

SMJ

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Objectives:To introduce an effective and safe ophthalmic triaging system to be used by non-ophthalmologists.Methods:A modified scoring triage system with more relevant clinical symptoms and signs from a previously published Rome Eye Scoring System for Urgency and Emergency (RESCUE) was evaluated over a 2-month period. The study was conducted following a prospective cohort design between March and September 2014 at King Abdulaziz University Hospital, Riyadh, Saudi Arabia. Only self-referred patients were included. Its reliability in differentiating urgent and semi-urgent conditions from non-urgent conditions, identifying patients who need immediate intervention, and decreasing the waiting time were tested using Mann Whitney U test.Results:A total of 531 patients were included in the validation phase to evaluate the triaging system reliability, and 824 patients were included in the implementation phase (applying the system in the ophthalmology emergency room). The sensitivity to differentiate urgent and semi-urgent conditions from non-urgent conditions improved from 90.7 to 98.7%, while the specificity decreased from 97.2 to 87% compared with RESCUE. The sensitivity in differentiating urgent conditions from semi-urgent and non-urgent conditions was 99%, and the specificity was 90%. Mean waiting time reduced from 58.23 minutes to 46 minutes (p=0.014), and the median waiting time reduced from 46 minutes to 33 minutes (p=0.009).Conclusion:This triage system appears to be safe and effective in recognizing the urgency of different ophthalmic conditions, reducing unnecessary ophthalmic emergency load and waiting time significantly.

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Triage Protocol: Both Undertriage and Overtriage Need to Be Evaluated

Cited by 45 publications

References 2 publications

Factors Associated With Trauma Center Use for Elderly Patients With Trauma

Factors Associated With Trauma Center Use for Elderly Patients With Trauma

A simplified trauma triage system safely reduces overtriage and improves provider satisfaction: a prospective study

Triaging self-referred patients attending ophthalmic emergency room

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