Accuracy of Initial Critical Care Triage Decisions in Blast Versus Non-Blast Trauma. (20th June 2014)

• Record Type: Journal Article
• Authors: Lipsky, Ari M.; Klein, Yoram; Givon, Adi; Klein, Moti; Hammond, Jeffrey S.; Peleg, Kobi; Israeli Trauma Group (ITG)
• Is Part Of: Disaster medicine and public health preparedness. Volume 8:Number 4(2014:Aug.)
• Page Start: 326
• Page End: 332
• Publication Date: 2014-06-20
• Subjects: Disaster medicine -- Periodicals; Emergency management -- Planning -- Periodicals; Public health -- Periodicals; 363.34
• DOI: 10.1017/dmp.2014.47
• Languages: English
• ISSNs: 1935-7893

Abstract

<abstract abstract-type="normal"> <title>ABSTRACT</title> <sec id="abs1" sec-type="general"> <title>Objective</title> <p>We investigated the accuracy of initial critical care triage in blast-injured versus non-blast-injured trauma patients, focusing on those inappropriately triaged to the intensive care unit (ICU) for brief (<16 h) stays.</p> </sec> <sec id="abs2" sec-type="methods"> <title>Methods</title> <p>We conducted a retrospective review of the Israel National Trauma Registry, applying a predetermined definition of need for initial ICU admission.</p> </sec> <sec id="abs3" sec-type="results"> <title>Results</title> <p>A total of 883 blast-injured and 112 185 non-blast-injured patients were categorized according to their need for ICU admission. Of these admissions, 5.7% in the blast setting and 8.4% in the non-blast setting were considered unnecessary. The sensitivity, specificity, and positive and negative likelihood ratios for the triage officers' decisions in assigning patients to the ICU were 95.5%, 98.8%, 77.2, and 0.05, respectively, in the blast setting, and 91.2%, 99.5%, 200.5, and 0.09, respectively, in the non-blast setting.</p> </sec> <sec id="abs4" sec-type="conclusions"> <title>Conclusions</title> <p>Triage officers do a better job sending to the ICU only those patients who require initial intensive care in the non-blast setting, though this is obscured by a much greater overall need for ICU-level care in the blast setting. Implementing triage protocols in the blast setting may help reduce the number of patients sent initially to the ICU for brief periods, thus increasing the availability of this resource. (<italic>Disaster Med Public Health Preparedness</italic>. 2014;0:1–7)</p> </sec> </abstract>