Effectiveness of a 2-specialty, 2-tiered triage and trauma team activation protocol

Ann Emerg Med. 1998 Oct;32(4):436-41. doi: 10.1016/s0196-0644(98)70172-6.


Study objective: To determine the effectiveness, safety, and resource allocation of a 2-specialty, 2-tiered triage and trauma team activation protocol.

Methods: We conducted a 6-month retrospective analysis of a 2-specialty, 2-tiered trauma team activation system at an urban Level I trauma center. Based on prehospital data, patients with a high likelihood of serious injury were assigned to triage category 1 and patients with a low likelihood of serious injury were assigned to category 2. Category 1 patients were immediately evaluated by both emergency medicine and trauma services. Category 2 patients were evaluated initially by emergency medicine staff with a mandatory trauma service consultation. Main outcomes measured included mortality, need for emergency procedures, need for emergency surgery, complications, and discharge disposition. Potential physician-hours saved were calculated for category 2 cases.

Results: Five hundred sixty-one patients were assigned a triage classification (272 to category 1 and 289 to category 2). Category 1 patients had a higher mortality rate (95% confidence interval [CI] for difference of 15.9%, 11.1% to 20.7%, P < .0001), need for emergency surgery (10.7% versus 1.4%, 95% CI for difference of 9.3%, 5.2% to 13.4%; P < .0001), need for emergency procedures (89% of total procedures, 95% CI 83% to 95%; P < .0001), and discharges to rehabilitation facilities (95% CI for difference of 15.1%, 9.3% to 21.0%; P < .0001). The 2-tiered response system saved an estimated 578 physician-hours of time for the trauma service over the study period.

Conclusion: This evaluation tool effectively predicts likelihood of serious injury, mortality, need for emergency surgery, and need for rehabilitation. Patients with a low likelihood of serious injury may be initially evaluated by the emergency medicine service effectively and safely, thus allowing more efficient use of surgical personnel.

MeSH terms

  • Algorithms
  • Chi-Square Distribution
  • Emergency Service, Hospital / organization & administration
  • Health Care Rationing
  • Hospitals, Urban / organization & administration
  • Humans
  • Outcome Assessment, Health Care
  • Patient Care Team / organization & administration*
  • Retrospective Studies
  • Statistics, Nonparametric
  • Triage / organization & administration*