Re-triage Optimization

Project: Research project

Project Details

Description

A. SUMMARY
150,000 Americans die annually from traumatic injury and between 50-90% of these deaths are due to trauma related hemorrhage.1 Addressing trauma related hemorrhage and trauma related coagulopathy is the single largest opportunity to reduce injury associated mortality and could be accomplished by improving timeliness to trauma care that provides hemorrhage control to all severely injured patients (injury severity score >15).2 The American College of Surgeons Committee on Trauma (ACS-COT) recommends severely injured patients go to verified, high-level (level I or II) trauma centers, where injury-associated mortality is the lowest.3, 4 High-level trauma centers are equipped at all times to provide contemporary resuscitations with 1:1:1 massive transfusion protocols, agents to address trauma related coagulopathy such as prothrombin complex concentrate, fibrinogen concentrate, idarucizumab, and andexanet-alfa in addition to the structural and human capital necessary for trauma care that provides definitive hemorrhage control via surgical and interventional radiological interventions. Likely because of these resources, severely injured patients cared for at high-level trauma centers are more likely to survive.5-7
However, despite field triage algorithms, emergency medical services misdirect 17-34% of severely injured to less equipped facilities, non-trauma and low-level trauma centers.8, 9 Re-triage of misdirected patients is the transfer of patients from non and low-level trauma centers to high-level trauma centers, and it reduces injury-associated mortality. However, 30-50% misdirected severely injured patients are not re-triaged.10, 11 Resource-rich, non-trauma and low-level trauma, teaching hospitals in urban settings are the least likely to re-triage severely injured patients,12 particularly if patients are insured.13 We do not know why. Re-triage has been studied with discharge datasets and trauma registries, but these data do not capture how and why patients are re-triaged or not. In my previous work I have established that nearly 30% of definitive hemorrhage control procedures occur more than 24 after injury. Re-triage can improve timeliness to definitive hemorrhage control and therefore injury-associated mortality. However, improvement in re-triage cannot occur until we understand re-triage processes and why re-triage fails to occur.
StatusActive
Effective start/end date7/1/206/30/21

Funding

  • American Association for the Surgery of Trauma (AGMT 6/15/20)

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