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Accuracy of Initial Critical Care Triage Decisions in Blast Versus Non-Blast Trauma

Published online by Cambridge University Press:  20 June 2014

Ari M. Lipsky ,
Yoram Klein ,
Adi Givon ,
Moti Klein ,
Jeffrey S. Hammond ,
Kobi Peleg  and
Israeli Trauma Group (ITG)
Ari M. Lipsky*
Affiliation:
National Center for Trauma and Emergency Medicine Research, The Gertner Institute for Health Policy and Epidemiology, Tel Hashomer, Israel Department of Emergency Medicine, Rambam Health Care Campus, Haifa, Israel
Yoram Klein
Affiliation:
Division of Trauma and Emergency Surgery, Department of Surgery, Kaplan Medical Center, Rehovot, Israel
Adi Givon
Affiliation:
National Center for Trauma and Emergency Medicine Research, The Gertner Institute for Health Policy and Epidemiology, Tel Hashomer, Israel
Moti Klein
Affiliation:
Division of Anesthesiology and Critical Care Medicine, Soroka Medical Center, Beer Sheva, Israel
Jeffrey S. Hammond
Affiliation:
Department of Surgery, University of Medicine and Dentistry of New Jersey-Robert Wood Johnson Medical School, New Brunswick, New Jersey
Kobi Peleg
Affiliation:
National Center for Trauma and Emergency Medicine Research, The Gertner Institute for Health Policy and Epidemiology, Tel Hashomer, Israel Disaster Medicine Department, School of Public Health, Tel Aviv University, Tel Aviv, Israel
Israeli Trauma Group (ITG)
Affiliation:
National Center for Trauma and Emergency Medicine Research, The Gertner Institute for Health Policy and Epidemiology, Tel Hashomer, Israel Department of Emergency Medicine, Rambam Health Care Campus, Haifa, Israel Division of Trauma and Emergency Surgery, Department of Surgery, Kaplan Medical Center, Rehovot, Israel Division of Anesthesiology and Critical Care Medicine, Soroka Medical Center, Beer Sheva, Israel Disaster Medicine Department, School of Public Health, Tel Aviv University, Tel Aviv, Israel Department of Surgery, University of Medicine and Dentistry of New Jersey-Robert Wood Johnson Medical School, New Brunswick, New Jersey
*
Correspondence and reprint requests to Ari M. Lipsky, MD, PhD, Department of Emergency Medicine, Rambam Health Care Campus, PO Box 9602, Haifa, Israel 31096 (e-mail: aril@alum.mit.edu).
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Abstract

Objective

We investigated the accuracy of initial critical care triage in blast-injured versus non-blast-injured trauma patients, focusing on those inappropriately triaged to the intensive care unit (ICU) for brief (<16 h) stays.

Methods

We conducted a retrospective review of the Israel National Trauma Registry, applying a predetermined definition of need for initial ICU admission.

Results

A total of 883 blast-injured and 112 185 non-blast-injured patients were categorized according to their need for ICU admission. Of these admissions, 5.7% in the blast setting and 8.4% in the non-blast setting were considered unnecessary. The sensitivity, specificity, and positive and negative likelihood ratios for the triage officers' decisions in assigning patients to the ICU were 95.5%, 98.8%, 77.2, and 0.05, respectively, in the blast setting, and 91.2%, 99.5%, 200.5, and 0.09, respectively, in the non-blast setting.

Conclusions

Triage officers do a better job sending to the ICU only those patients who require initial intensive care in the non-blast setting, though this is obscured by a much greater overall need for ICU-level care in the blast setting. Implementing triage protocols in the blast setting may help reduce the number of patients sent initially to the ICU for brief periods, thus increasing the availability of this resource. (Disaster Med Public Health Preparedness. 2014;0:1–7)

Keywords

triageintensive carewounds and injuriesblast injuriesmass casualty incidents
Type
Original Research
Information
Disaster Medicine and Public Health Preparedness , Volume 8 , Issue 4 , August 2014 , pp. 326 - 332
Copyright
Copyright © Society for Disaster Medicine and Public Health, Inc. 2014 

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References

1. Kaji, AH, Koenig, KL, Lewis, RJ. Current hospital disaster preparedness. JAMA. 2007; 298:2188-2190.Google Scholar
2. Kaji, A, Koenig, KL, Bey, T. Surge capacity for healthcare systems: a conceptual framework. Acad Emerg Med. 2006; 13:1157-1159.Google Scholar
3. Devereaux, A, Christian, MD, Dichter, JR, Geiling, JA, Rubinson, L. Task Force for Mass Critical Care. Summary of suggestions from the Task Force for Mass Critical Care summit, January 26-27, 2007. Chest. 2008; 133(suppl 5):1S-7S.Google Scholar
4. Sprung, CL, Zimmerman, JL, Christian, MD, et al. Recommendations for intensive care unit and hospital preparations for an influenza epidemic or mass disaster: summary report of the European Society of Intensive Care Medicine’s Task Force for intensive care unit triage during an influenza epidemic or mass disaster. Intensive Care Med. 2010; 36(3):428-443.Google Scholar
5. Frykberg, ER. Medical management of disasters and mass casualties from terrorist bombings: how can we cope? J Trauma. 2002; 53:201-212.Google Scholar
6. Peleg, K, Aharonson-Daniel, L, Stein, M, et al. Gunshot and explosion injuries. Ann Surg. 2004; 239:311-318.Google Scholar
7. Aharonson-Daniel, L, Waisman, Y, Dannon, YL, Peleg, K; Members of the Israel Trauma Group. Epidemiology of terror-related versus non-terror-related traumatic injury in children. Pediatrics. 2003; 112:e280.Google Scholar
8. Einav, S, Aharonson-Daniel, L, Weissman, C, Freund, HR, Peleg, K; Israel Trauma Group. In-hospital resource utilization during multiple casualty incidents. Ann Surg. 2006; 243:533-540.Google Scholar
9. National Center for Health Statistics. The International Classification of Diseases, Ninth Revision, Clinical Modification , 6th ed; 1998. ftp://ftp.cdc.gov/pub/Health_Statistics/NCHS/Publications/ICD9-CM/1998/. Accessed June 5, 2014.Google Scholar
10. Barell, V, Aharonson-Daniel, L, Fingerhut, LA, et al. An introduction to the Barell body region by nature of injury diagnosis matrix. Inj Prev. 2002; 8:91-96.Google Scholar
11. Jaeschke, R, Guyatt, GH, Sackett, DL. Users' guides to the medical literature. III. How to use an article about a diagnostic test. B. What are the results and will they help me in caring for my patients? The Evidence-Based Medicine Working Group. JAMA. 1994; 271:703-707.Google Scholar
12. Devereaux, A, Dichter, JR, Christian, MD, et al. Definitive care for the critically ill during a disaster: a framework for allocation of scarce resources in mass critical care: from a Task Force for Mass Critical Care summit meeting, January 26-27, 2007, Chicago, IL. Chest. 2008; 133(suppl 5):51S-66S.Google Scholar
13. Romig, LE.. Pediatric triage: a system to JumpSTART your triage of young patients at MCIs. JEMS. 2002; 27:52-58, 60-63.Google Scholar
14. Christian, MD, Joynt, GM, Hick, JL, et al. Chapter 7. Critical care triage: recommendations and standard operating procedures for intensive care unit and hospital preparations for an influenza epidemic or mass disaster. Intensive Care Med. 2010; 36(suppl 1):S55-S64.Google Scholar
15. Frykberg, ER, Tepas, JJ. Terrorist bombings: lessons learned from Belfast to Beirut. Ann Surg. 1988; 208:569-576.Google Scholar
16. Christian, MD, Hamielec, C, Lazar, NM, et al. A retrospective cohort pilot study to evaluate a triage tool for use in a pandemic. Crit Care. 2009; 13(5):R170.Google Scholar
17. Guest, T, Tantam, G, Donlin, N, Tantam, K, McMillan, H, Tillyard, A. An observational cohort study of triage for critical care provision during pandemic influenza: ‘clipboard physicians’ or ‘evidenced based medicine’? Anaesthesia. 2009; 64:1199-1206.Google Scholar