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

Published online by Cambridge University Press:  20 June 2014

Ari M. Lipsky ,
Yoram Klein ,
Adi Givon ,
Moti Klein ,
Jeffrey S. Hammond ,
Kobi Peleg  and
Israeli Trauma Group (ITG)
Ari M. Lipsky*
Affiliation:
National Center for Trauma and Emergency Medicine Research, The Gertner Institute for Health Policy and Epidemiology, Tel Hashomer, Israel Department of Emergency Medicine, Rambam Health Care Campus, Haifa, Israel
Yoram Klein
Affiliation:
Division of Trauma and Emergency Surgery, Department of Surgery, Kaplan Medical Center, Rehovot, Israel
Adi Givon
Affiliation:
National Center for Trauma and Emergency Medicine Research, The Gertner Institute for Health Policy and Epidemiology, Tel Hashomer, Israel
Moti Klein
Affiliation:
Division of Anesthesiology and Critical Care Medicine, Soroka Medical Center, Beer Sheva, Israel
Jeffrey S. Hammond
Affiliation:
Department of Surgery, University of Medicine and Dentistry of New Jersey-Robert Wood Johnson Medical School, New Brunswick, New Jersey
Kobi Peleg
Affiliation:
National Center for Trauma and Emergency Medicine Research, The Gertner Institute for Health Policy and Epidemiology, Tel Hashomer, Israel Disaster Medicine Department, School of Public Health, Tel Aviv University, Tel Aviv, Israel
Israeli Trauma Group (ITG)
Affiliation:
National Center for Trauma and Emergency Medicine Research, The Gertner Institute for Health Policy and Epidemiology, Tel Hashomer, Israel Department of Emergency Medicine, Rambam Health Care Campus, Haifa, Israel Division of Trauma and Emergency Surgery, Department of Surgery, Kaplan Medical Center, Rehovot, Israel Division of Anesthesiology and Critical Care Medicine, Soroka Medical Center, Beer Sheva, Israel Disaster Medicine Department, School of Public Health, Tel Aviv University, Tel Aviv, Israel Department of Surgery, University of Medicine and Dentistry of New Jersey-Robert Wood Johnson Medical School, New Brunswick, New Jersey
*
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).
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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)

Keywords

triageintensive carewounds and injuriesblast injuriesmass casualty incidents
Type
Original Research
Information
Disaster Medicine and Public Health Preparedness , Volume 8 , Issue 4 , August 2014 , pp. 326 - 332
Copyright
Copyright © Society for Disaster Medicine and Public Health, Inc. 2014 

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