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Simplified System Reduces Overtriage in Trauma Patients

Last Updated: September 23, 2009.

A simplified triage system based on only four variables considerably reduces the overtriage rate with an acceptable undertriage rate in trauma patients, according to a study in the September issue of the Archives of Surgery.

WEDNESDAY, Sept. 23 (HealthDay News) -- A simplified triage system based on only four variables considerably reduces the overtriage rate with an acceptable undertriage rate in trauma patients, according to a study in the September issue of the Archives of Surgery.

Ryan Lehmann, D.O., and colleagues from Madigan Army Medical Center in Tacoma, Wash., compared the effectiveness of their current complex triage system with a simplified system based on only four highly predictive variables on 244 trauma patients seen at their institution. The four variables were identified from a previous study: hypotension, mental status, altered respirations, and penetrating truncal wound. Overtriage and undertriage were determined based on the need for immediate emergency interventions or operative procedures.

The researchers found that 21 percent of patients needed urgent intervention. The overtriage rate was 79 percent, the undertriage rate was 1 percent, and the mistriage rate was 14 percent for the current system. The most common reasons for mistriage were discretion of the emergency department physician and misunderstanding the triage criteria. With the simplified system, overtriage fell significantly to 12 percent, while undertriage rose significantly to 4 percent. Undertriage was not associated with deaths in either system.

"Using a simplified triage system can safely reduce the rate of overtriage," Lehmann and colleagues conclude. "This could conserve resources, reduce mistriage from misunderstood guidelines, and improve specificity by including only those variables with high predictive value."

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