Impact of Triage Guidelines on Prehospital Triage: Comparison of Guidelines With a Statistical Model

Priti Parikh; Pratik J. Parikh; Bradley R. Guthrie; Logan Mamer; Melissa L. Whitmill; Timothy Erskine; Jonathan M. Saxe

doi:10.1016/j.jss.2017.06.084

Impact of Triage Guidelines on Prehospital Triage: Comparison of Guidelines With a Statistical Model

Priti Parikh, Pratik J. Parikh, Bradley R. Guthrie, Logan Mamer, Melissa L. Whitmill, Timothy Erskine, Jonathan M. Saxe

Surgery

Research output: Contribution to journal › Article › peer-review

Abstract

<p> <h3 id="x-x-sectitle0015"> Background </h3> <p id="x-x-abspara0010"> The American College of Surgeons developed the National <a href="https://www.sciencedirect.com/topics/medicine-and-dentistry/field-triage" title="Learn more about Field triage"> Field Triage </a> Decision Scheme (NFTDS) that has been adapted by many trauma centers in the nation, but quantitative evidence of its efficacy is unclear. We compare the NFTDS and state of Ohio guidelines to the “observed” rates and with rates derived using a statistical model. <h3 id="x-x-sectitle0020"> Methods </h3> <p id="x-x-abspara0015"> We used 4757 trauma records from 2008-2012 available from the state and calculated undertriage (UT) and overtriage (OT) rates. We then simulated the NFTDS and the state guidelines for those years and estimated the corresponding UT and OT rates. We finally compared these rates with those derived from a multivariate logistic regression model. <h3 id="x-x-sectitle0025"> Results </h3> <p id="x-x-abspara0020"> For the state data, both NFTDS and state guidelines produced lower UT rate (&sim;9%) compared with the observed rate (&sim;17%), whereas the OT rates were higher (>85%) than the observed rates (&sim;54%). The statistical model identified novel factors that were not directly available in the NFTDS; change in responsiveness (odds ratio [OR] = 1.924) and complaint in body (OR = 3.140), back (OR = 1.890), chest (OR = 3.191), head (OR = 3.878), and abdomen (OR = 2.966). Although the statistical model performed similar to observed rates, it performed considerably better than NFTDS (UT = 1.93% <em> versus </em> 9.03%; OT = 66.42% <em> versus </em> 87.52%) and state guidelines (UT = 2.18% <em> versus </em> 8.72%; OT = 64.09% <em> versus </em> 86.52%). <h3 id="x-x-sectitle0030"> Conclusions </h3> <p id="x-x-abspara0025"> The current NFTDS and state's <a href="https://www.sciencedirect.com/topics/medicine-and-dentistry/triage" title="Learn more about Triage"> triage </a> guidelines do not appear to achieve the ACS recommendation of <5% UT and <35% OT rates in the state of Ohio. Inclusion of region-specific factors may help enhance the current NFTDS guidelines and aid in the first impression or judgment of the Emergency Medical Services personnel to improve trauma care and reduce cost. </p> </p> </p> </p></p>

Original language	American English
Journal	Journal of Surgical Research
Volume	220
DOIs	https://doi.org/10.1016/j.jss.2017.06.084
State	Published - Dec 1 2017

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Medicine and Health Sciences
Surgery

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@article{190c207b757f43658e52532f67a77800,

title = "Impact of Triage Guidelines on Prehospital Triage: Comparison of Guidelines With a Statistical Model",

abstract = " Background The American College of Surgeons developed the National Field Triage Decision Scheme (NFTDS) that has been adapted by many trauma centers in the nation, but quantitative evidence of its efficacy is unclear. We compare the NFTDS and state of Ohio guidelines to the “observed” rates and with rates derived using a statistical model. Methods We used 4757 trauma records from 2008-2012 available from the state and calculated undertriage (UT) and overtriage (OT) rates. We then simulated the NFTDS and the state guidelines for those years and estimated the corresponding UT and OT rates. We finally compared these rates with those derived from a multivariate logistic regression model. Results For the state data, both NFTDS and state guidelines produced lower UT rate (&sim;9%) compared with the observed rate (&sim;17%), whereas the OT rates were higher (>85%) than the observed rates (&sim;54%). The statistical model identified novel factors that were not directly available in the NFTDS; change in responsiveness (odds ratio [OR] = 1.924) and complaint in body (OR = 3.140), back (OR = 1.890), chest (OR = 3.191), head (OR = 3.878), and abdomen (OR = 2.966). Although the statistical model performed similar to observed rates, it performed considerably better than NFTDS (UT = 1.93% versus 9.03%; OT = 66.42% versus 87.52%) and state guidelines (UT = 2.18% versus 8.72%; OT = 64.09% versus 86.52%). Conclusions The current NFTDS and state's triage guidelines do not appear to achieve the ACS recommendation of <5% UT and <35% OT rates in the state of Ohio. Inclusion of region-specific factors may help enhance the current NFTDS guidelines and aid in the first impression or judgment of the Emergency Medical Services personnel to improve trauma care and reduce cost. ",

author = "Priti Parikh and Parikh, {Pratik J.} and Guthrie, {Bradley R.} and Logan Mamer and Whitmill, {Melissa L.} and Timothy Erskine and Saxe, {Jonathan M.}",

year = "2017",

month = dec,

day = "1",

doi = "10.1016/j.jss.2017.06.084",

language = "American English",

volume = "220",

journal = "Journal of Surgical Research",

}

TY - JOUR

T1 - Impact of Triage Guidelines on Prehospital Triage: Comparison of Guidelines With a Statistical Model

AU - Parikh, Priti

AU - Parikh, Pratik J.

AU - Guthrie, Bradley R.

AU - Mamer, Logan

AU - Whitmill, Melissa L.

AU - Erskine, Timothy

AU - Saxe, Jonathan M.

PY - 2017/12/1

Y1 - 2017/12/1

N2 - Background The American College of Surgeons developed the National Field Triage Decision Scheme (NFTDS) that has been adapted by many trauma centers in the nation, but quantitative evidence of its efficacy is unclear. We compare the NFTDS and state of Ohio guidelines to the “observed” rates and with rates derived using a statistical model. Methods We used 4757 trauma records from 2008-2012 available from the state and calculated undertriage (UT) and overtriage (OT) rates. We then simulated the NFTDS and the state guidelines for those years and estimated the corresponding UT and OT rates. We finally compared these rates with those derived from a multivariate logistic regression model. Results For the state data, both NFTDS and state guidelines produced lower UT rate (&sim;9%) compared with the observed rate (&sim;17%), whereas the OT rates were higher (>85%) than the observed rates (&sim;54%). The statistical model identified novel factors that were not directly available in the NFTDS; change in responsiveness (odds ratio [OR] = 1.924) and complaint in body (OR = 3.140), back (OR = 1.890), chest (OR = 3.191), head (OR = 3.878), and abdomen (OR = 2.966). Although the statistical model performed similar to observed rates, it performed considerably better than NFTDS (UT = 1.93% versus 9.03%; OT = 66.42% versus 87.52%) and state guidelines (UT = 2.18% versus 8.72%; OT = 64.09% versus 86.52%). Conclusions The current NFTDS and state's triage guidelines do not appear to achieve the ACS recommendation of <5% UT and <35% OT rates in the state of Ohio. Inclusion of region-specific factors may help enhance the current NFTDS guidelines and aid in the first impression or judgment of the Emergency Medical Services personnel to improve trauma care and reduce cost.

AB - Background The American College of Surgeons developed the National Field Triage Decision Scheme (NFTDS) that has been adapted by many trauma centers in the nation, but quantitative evidence of its efficacy is unclear. We compare the NFTDS and state of Ohio guidelines to the “observed” rates and with rates derived using a statistical model. Methods We used 4757 trauma records from 2008-2012 available from the state and calculated undertriage (UT) and overtriage (OT) rates. We then simulated the NFTDS and the state guidelines for those years and estimated the corresponding UT and OT rates. We finally compared these rates with those derived from a multivariate logistic regression model. Results For the state data, both NFTDS and state guidelines produced lower UT rate (&sim;9%) compared with the observed rate (&sim;17%), whereas the OT rates were higher (>85%) than the observed rates (&sim;54%). The statistical model identified novel factors that were not directly available in the NFTDS; change in responsiveness (odds ratio [OR] = 1.924) and complaint in body (OR = 3.140), back (OR = 1.890), chest (OR = 3.191), head (OR = 3.878), and abdomen (OR = 2.966). Although the statistical model performed similar to observed rates, it performed considerably better than NFTDS (UT = 1.93% versus 9.03%; OT = 66.42% versus 87.52%) and state guidelines (UT = 2.18% versus 8.72%; OT = 64.09% versus 86.52%). Conclusions The current NFTDS and state's triage guidelines do not appear to achieve the ACS recommendation of <5% UT and <35% OT rates in the state of Ohio. Inclusion of region-specific factors may help enhance the current NFTDS guidelines and aid in the first impression or judgment of the Emergency Medical Services personnel to improve trauma care and reduce cost.

UR - https://corescholar.libraries.wright.edu/surg/723

U2 - 10.1016/j.jss.2017.06.084

DO - 10.1016/j.jss.2017.06.084

M3 - Article

C2 - 29180189

VL - 220

JO - Journal of Surgical Research

JF - Journal of Surgical Research

ER -

Impact of Triage Guidelines on Prehospital Triage: Comparison of Guidelines With a Statistical Model

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