Implementation of a two-tier trauma response

Injury. 1998 Nov;29(9):677-83. doi: 10.1016/s0020-1383(98)00161-2.


Objective: To apply a triage tool to patients on their arrival in the emergency department and determine the efficacy and safety of a two-tier trauma response.

Design: Descriptive prospective audit.

Setting: Principal urban referral hospital that provides a major trauma service.

Materials and methods: The triage tool designated a major trauma or stable trauma response. A major trauma designation mobilised a multidisciplinary team and a stable trauma designation an expedited evaluation by emergency department staff. Chi-square test and Mann-Whitney U test were used to compare major and stable trauma designations. Triage accuracy was evaluated using outcome variables.

Main results: 78% of 58 major trauma responses and 30% of 180 stable trauma responses were admitted. The median injury severity score (and interquartile range) of admitted patients was 9.0 (5.0-19.5) for major responses and 5.0 (2.0-9.0) for stable responses. The triage tool had a sensitivity of 65%, specificity of 87%, accuracy (appropriate triage rate) of 82%, undertriage rate of 8% and overtriage rate of 10%.

Conclusion: The triage tool adequately distinguished between patients with and without major trauma. Undertriaged patients had timely and appropriate referral for definitive surgical care and had no adverse outcomes.

MeSH terms

  • Adolescent
  • Adult
  • Aged
  • Aged, 80 and over
  • Child, Preschool
  • Clinical Protocols
  • Emergency Service, Hospital / organization & administration*
  • Female
  • Hospitalization
  • Hospitals, Urban / organization & administration
  • Humans
  • Injury Severity Score
  • Male
  • Medical Audit
  • Middle Aged
  • New South Wales
  • Prospective Studies
  • Trauma Centers / organization & administration
  • Triage / methods*
  • Wounds and Injuries / classification*
  • Wounds and Injuries / therapy