Assessing field triage decisions and the international classification injury severity score (ICISS) at predicting outcomes of trauma patients

Casey J. Allen, Daniel J. Baldor, Carl I Schulman, Louis R Pizano, Alan Livingstone, Nicholas Namias

Research output: Contribution to journalArticle

Abstract

Florida considers the International Classification Injury Severity Score (ICISS) from hospital discharges within a geographic region in the apportionment of trauma centers (TCs). Patients with an ICISS < 0.85 are considered to require triage to a TC, yet many are triaged to an emergency department (ED).We assess outcomes of those with an ICISS < 0.85 by the actual triage decision of emergency medical services (EMS). From October 2011 to October 2013, 39,021 consecutive admissions with injury ICD-9 codes were analyzed. ICISS was calculated from the product of the survival risk ratios for a patient's three worst injuries. Outcomes were compared between patients with ICISS < 0.85 either triaged to the ED or its separate, neighboring, free-standing TC at a large urban hospital. A total of 32,191 (83%) patients were triaged to the ED by EMS and 6,827 (17%) were triaged to the TC. Of these, 2544 had an ICISS < 0.85, with 2145 (84%) being triaged to the TC and 399 (16%) to the ED. In these patients, those taken to the TC more often required admission, and those taken to the ED had better outcomes. When the confounders influencing triage to an ED or a TC are eliminated, those triaged by EMS to the ED rather than the TC had better overall outcomes. EMS providers better identified patients at risk for mortality than did the retrospective application of ICISS. ICISS < 0.85 does not identify the absolute need for TC as EMS providers were able to appropriately triage a large portion of this population to the ED.

Original languageEnglish (US)
Pages (from-to)648-652
Number of pages5
JournalAmerican Surgeon
Volume83
Issue number6
StatePublished - Jun 1 2017

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Injury Severity Score
Triage
Trauma Centers
Hospital Emergency Service
Emergency Medical Services
Wounds and Injuries
International Classification of Diseases
Urban Hospitals
Odds Ratio
Survival
Mortality

ASJC Scopus subject areas

  • Surgery
  • Medicine(all)

Cite this

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title = "Assessing field triage decisions and the international classification injury severity score (ICISS) at predicting outcomes of trauma patients",
abstract = "Florida considers the International Classification Injury Severity Score (ICISS) from hospital discharges within a geographic region in the apportionment of trauma centers (TCs). Patients with an ICISS < 0.85 are considered to require triage to a TC, yet many are triaged to an emergency department (ED).We assess outcomes of those with an ICISS < 0.85 by the actual triage decision of emergency medical services (EMS). From October 2011 to October 2013, 39,021 consecutive admissions with injury ICD-9 codes were analyzed. ICISS was calculated from the product of the survival risk ratios for a patient's three worst injuries. Outcomes were compared between patients with ICISS < 0.85 either triaged to the ED or its separate, neighboring, free-standing TC at a large urban hospital. A total of 32,191 (83{\%}) patients were triaged to the ED by EMS and 6,827 (17{\%}) were triaged to the TC. Of these, 2544 had an ICISS < 0.85, with 2145 (84{\%}) being triaged to the TC and 399 (16{\%}) to the ED. In these patients, those taken to the TC more often required admission, and those taken to the ED had better outcomes. When the confounders influencing triage to an ED or a TC are eliminated, those triaged by EMS to the ED rather than the TC had better overall outcomes. EMS providers better identified patients at risk for mortality than did the retrospective application of ICISS. ICISS < 0.85 does not identify the absolute need for TC as EMS providers were able to appropriately triage a large portion of this population to the ED.",
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AU - Livingstone, Alan

AU - Namias, Nicholas

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