Trauma Triage - Room for Improvement

Andrew-Paul Deeb, MD (Advisor: Joshua Brown, MD, MSc)

Field triage in trauma must be accurate to match injured patients to the appropriate level of care. Existing criteria must aim to minimize under-triage. Under triage occurs more frequently in the geriatric patients and also in rural settings. We separately investigated these two populations. The geriatric patient population is unique and increasingly recognized to mount a different response to injury. Triage protocols should be revised to more accurately classify these patients. We looked at geriatric patients with severe head injury and compared the use of GCS vs GCS-motor as a triage criterion. GCS motor has been shown to be as accurate and more reliable to employ in the field for adult patients. We suggest that this may not be a safe criterion modification in geriatric patients.

Another challenge with under-triage is dependent on where the patient is injured. We analyze the disparities in field triage between rural vs urban patients and identify the specific triage criteria associated with under-triage in these settings. We identified factors that should help to reduce the higher under-triage observed in the rural setting.