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EXPEDITING TREATMENT OF TRAUMA PATIENTS IN THE ED: RAPID TRAUMA EVALUATION (RTE)

Published:December 23, 2022DOI:https://doi.org/10.1016/j.jemermed.2022.12.022

      Abstract

      Objective

      We developed, implemented, and evaluated a Rapid Trauma Evaluation (RTE) process to determine whether a subset of trauma patients not meeting pre-established trauma criteria would benefit from a faster evaluation.

      Methods

      This was a retrospective study conducted from July 2019 to May 2020 for patients aged > 65 years with ground-level fall within 24 h, or involved in a motorcycle collision (MCC), who arrived via emergency medical services (EMS) and did not meet established American College of Surgery (ACS) trauma criteria. Upon arrival to the Emergency Department (ED), patients were evaluated by a nurse or emergency medical technician using the RTE process, which included immediate room placement, undressing/gowning, vital signs, and a head-to-toe assessment with immediate physician notification of abnormal findings and upgrade of trauma status if required (ACS level 2 [modified] or ACS level 1 [full]). Number and type of admissions, discharges, trauma upgrades, and length of stay data were recorded. To reduce sampling bias, the historical control cohort was comprised of all patients seen in the ED 3 months prior to the implementation of the RTE (April–June 2019) who met the same criteria as our RTE cohort (i.e., patients > 65 years old who had a ground-level fall or MCCs not meeting trauma criteria who arrived to the ED via EMS).

      Results

      There were 755 patients included in the RTE cohort, of which 77% were falls and 23% were MCCs. The historical control included 575 patients, of which 92.3% were falls and 7.7% were MCCs. Within the RTE falls group, the median age was 82 years, with an interquartile range (IQR) of 74–88, and 42% were male. We found that 3.2% required a modified upgrade; 0.7% required a full upgrade and 55% were admitted, of which only 29.4% were trauma admissions, as the others had admitting diagnosis not trauma related, such as stroke and myocardial infarction. The historic falls control cohort had similar demographics with a median age of 81 years (IQR 67–88), 40.5% were male, and 57.4% required admission, with 22% being trauma admissions. In the RTE MCC group, the median age was 41.5 years (IQR 30–49), 84.4% male, in which 21.9% were upgraded: 6 were upgraded to a modified trauma and one was upgraded to a Full Trauma, and 43.8% required admission, of which 85.7% were trauma admissions. The historic MCC control cohort's median age was 29 years (IQR 23–41); 95.5% were male, 54.5% were admitted, of which 75% were trauma admissions.

      Conclusions

      We found that among patients who are 65 years and older who have a ground-level fall, or those in an MCC who arrive to our ED via EMS but did not meet our ACS trauma criteria, the RTE process may benefit this subset of patients by quickly identifying underlying medical issues or unrecognized injuries.

      Keywords

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