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Table 3 Simulation of theoretical over- and undertriage according to different single and combined ER trauma team activation criteria

From: Simple modification of trauma mechanism alarm criteria published for the TraumaNetwork DGU® may significantly improve overtriage – a cross sectional study

ERTTAC ISS ≤ 15 ISS > 15 total P over-triage under-triage
trauma patients treated in the ER N 1052 326 1378    
% 76.3% 23.7% 100.0%   
Transfer criterion       
transfer from external hospital no 936 253 1189 < 0.001 116/1052 253/326
yes 116 73 189 11.0% 77.6%
% 11.0% 22.4% 13.7%   
Mechanism of injury       
mechanism of injury (traffic) no 513 199 712 < 0.001 539/1052 199/326
yes 539 127 666 51.2% 61.0%
% 51.2% 39.0% 48.3%   
mechanism of injury (car /truck passenger only) no 726 288 1014 < 0.001 326/1052 288/326
yes 326 38 364 31.0% 88.3%
% 31.0% 11.7% 26.4%   
mechanism of injury (traffic, except car /truck passenger) no 839 237 1076 0.008 213/1052 237/326
yes 213 89 302 20.2% 72.7%
% 20.2% 27.3% 21.9%   
fall from height ≥ 3 m no 921 267 1188 0.01 131/1052 267/326
yes 131 59 190 12.5% 81.9%
% 12.5% 18.1% 13.8%   
penetrating injury (chest, abdomen) no 1020 314 1334 0.56 32/1052 314/326
yes 32 12 44 3.0% 96.3%
% 3.0% 3.7% 3.2%   
Combined mechanism of injury       
mechanism of injury (penetrating, traffic, fall ≥ 3 m) no 352 130 482 0.034 700/1052 130/326
yes 700 196 896 66.5% 39.9%
% 66.5% 60.1% 65.0%   
mechanism of injury without car criteria (penetrating, traffic, fall ≥ 3 m) no 677 168 845 < 0.001 375/1052 168/326
yes 375 158 533 35.6% 51.5%
% 35.6% 48.5% 38.7%   
Anatomic criterion       
EMS injury no 882 194 1076 < 0.001 170/1052 194/326
yes 170 132 302 16.2% 59.5%
% 16.2% 40.5% 21.9%   
Physiological criteria       
Intubation before arrival in ER no 1003 235 1238 < 0.001 49/1052 235/326
yes 49 91 140 4.7% 72.1%
% 4.7% 27.9% 10.2%   
intubation in ER no 1025 285 1310 < 0.001 27/1052 285/326
yes 27 41 68 2.6% 87.4%
% 2.6% 12.6% 4.9%   
SaO2 < 90% no 981 282 1263 < 0.001 71/1052 282/326
yes 71 44 115 6.7% 86.5%
% 6.7% 13.5% 8.3%   
systolic (BP < 90 mmHg) no 1028 310 1338 0.02 24/1052 310/326
yes 24 16 40 2.3% 95.1%
% 2.3% 4.9% 2.9%   
1st GCS < 14 no 897 178 1075 < 0.001 155/1052 178/326
yes 155 148 303 14.7% 54.6%
% 14.7% 45.4% 22.0%   
1st GCS < 9 no 992 236 1228 < 0.001 60/1052 236/326
yes 60 90 150 5.7% 72.4%
% 5.7% 27.6% 10.9%   
Combined physiological criteria       
physiological criteria (1st GCS < 14, intubation, SaO2 < 90%, BP < 90 mmHg) no 821 136 957 < 0.001 231/1052 136/326
yes 231 190 421 22.0% 41.7%
% 22.0% 58.3% 30.6%   
physiological criteria (1st GCS < 9, intubation, SaO2 < 90%, BP < 90 mmHg) no 888 164 1052 < 0.001 164/1052 164/326
yes 164 162 326 15.6% 50.3%
% 15.6% 49.7% 23.7%   
Overall combined criteria       
all criteria: 1st GCS < 14 no 139 15 154 < 0.001 913/1052 15/326
yes 913 311 1224 86.8% 4.6%
% 86.8% 95.4% 88.8%   
all criteria: 1st GCS < 9 no 167 24 191 < 0.001 885/1052 24/326
yes 885 302 1187 84.1% 7.4%
% 84.1% 92.6% 86.1%   
all criteria: 1st GCS < 14; without car criteria no 396 23 419 < 0.001 656/1052 23/326
yes 656 303 959 62.4% 7.1%
% 62.4% 92.9% 69.6%   
all criteria: 1st GCS < 9; without car criteria no 430 35 465 < 0.001 622/1052 35/326
yes 622 291 913 59.1% 10.7%
% 59.1% 89.3% 66.3%   
  1. ER emergency room, ERTTAC emergency room trauma team activation criteria, ISS injury severity score, BP blood pressure, SaO2 blood oxygen saturation, GCS Glasgow Coma Scale, EMS injury emergency medical service’s grading of injury severity: at least one grade severe or two moderate injuries; all criteria, mechanism, transfer, EMS injury, physiological