Tag Archives: trauma center

Is It A Trauma Center Or A Coffee Shop?

Tim Horton’s is a large franchise operation that runs about 3,750 coffee shops / restaurants in the US and Canada. Some of these franchises are located inside other establishments, such as hospitals. The outlet in the Royal Columbian Hospital in New Westminster, British Columbia, Canada is one such location, and it did double duty last month. Royal Columbian is the region’s trauma centre.

Due to a large number of patients being treated in the ED and some fly-ins from earlier in the day, the coffee shop was cleaned and converted to overflow for patient care. Six stretchers with privacy screens were set up and four patients were treated in the area. This situation lasted for about 90 minutes until the overcrowding eased. The shop was cleaned once again and ready to open normally the next morning, serving coffee, not patients.

Reference: BC Local News (www.bclocalnews.com)

Q&A: Is Undertriage Bad?

After my discourses on under- and over-triage in the last week, I received an interesting question from a reader: although undertriage seems bad from a theoretical standpoint, are there any objective negative consequences?

As you might imagine, there is little literature on this topic. The incidence is low, so it’s tough to design a study with enough power to come to any solid conclusions. There are two studies that I can cite that shed as much light on the subject as possible.

The first looks at system undertriage at the EMS level. A Canadian study looked at patients with severe injuries (identified by ISS>15 after admission) who were taken to trauma centers (correct triage) vs non-trauma centers (undertriage). After solid statistical analysis of over 11,000 patients, they found that mortality in the undertriage group was 24% higher than the correctly triaged patients.

A second study looked at undertriage in one trauma center (1,424 patients) using their standard triage criteria, not ISS. The undertriage group had a significantly lower ISS (17 vs 25). The correctly triaged patients were more frequently intubated in the ED, more likely to be admitted to the ICU, and had longer ICU and hospital stays. Mortality was not significantly different. The problem with this study is that most of the undertriage group probably did not need a trauma activation, based on their lower ISS. The higher ISS patients (who met triage criteria) needed an airway earlier and required critical care more often. These data show that the institution probably needs to adjust its triage criteria!

Bottom line: The Canadian study shows the danger of undertriage prior to reaching definitive care. There is no good literature that illustrates its danger once the patient is at a trauma center. But there is support for the converse idea that appropriately triaged patients get definitive management sooner (airway, critical care). Any takers for designing the study to answer this question?

References:

  1. Survival of the fittest: the hidden cost of undertriage of major trauma. J Amer Col Surgeons, 211:804-811, Dec 2010.
  2. Outcome assessment of blunt trauma patients who are undertriaged. Surgery 148(2): 239-245, Aug 2010.

Emergency Medicine & Trauma Update – Bloomington, MN 10/28/10

“Torso Trauma Update” presented at 8:40AM.

For a copy of the slideset, click here.

Bibliography:

  • What is the utility of focused assessment with sonography in trauma (FAST) exam in penetrating torso trauma? Injury, in press, 2010.
  • CT of blunt abdominal and pelvic vascular injury. Emerg Radiology 17:21-29, 2010
  • More operations, more deaths? Relationship between operative intervention and risk-adjusted mortality at trauma centers. J Trauma 69(1):70-77, 2010