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Accuracy of Initial Critical Care Triage Decisions in Blast Versus Non-Blast Trauma

  • Ari M. Lipsky (a1) (a2), Yoram Klein (a3), Adi Givon (a1), Moti Klein (a4), Jeffrey S. Hammond (a5), Kobi Peleg (a1) (a6) and Israeli Trauma Group (ITG) (a1) (a2) (a3) (a4) (a6) (a5)...

Abstract

Objective

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.

Methods

We conducted a retrospective review of the Israel National Trauma Registry, applying a predetermined definition of need for initial ICU admission.

Results

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.

Conclusions

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. (Disaster Med Public Health Preparedness. 2014;0:1–7)

Copyright

Corresponding author

Correspondence and reprint requests to Ari M. Lipsky, MD, PhD, Department of Emergency Medicine, Rambam Health Care Campus, PO Box 9602, Haifa, Israel 31096 (e-mail: aril@alum.mit.edu).

References

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Accuracy of Initial Critical Care Triage Decisions in Blast Versus Non-Blast Trauma

  • Ari M. Lipsky (a1) (a2), Yoram Klein (a3), Adi Givon (a1), Moti Klein (a4), Jeffrey S. Hammond (a5), Kobi Peleg (a1) (a6) and Israeli Trauma Group (ITG) (a1) (a2) (a3) (a4) (a6) (a5)...

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