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