A consensus-based criterion standard for trauma center need. J Trauma Acute Care Surg 2014 Apr;76(4):1157-63
Date
03/26/2014Pubmed ID
24662885DOI
10.1097/TA.0000000000000189Scopus ID
2-s2.0-84897045324 (requires institutional sign-in at Scopus site) 47 CitationsAbstract
BACKGROUND: In civilian trauma care, field triage is the process applied by prehospital care providers to identify patients who are likely to have severe injuries and immediately need the resources of a trauma center. Studies of the efficacy of field triage have used various measures to define trauma center need because no "criterion standard" exists, making cross-study comparisons difficult. This study aimed to develop a consensus-based functional criterion standard definition of trauma center need.
METHODS: Local and national experts were recruited for participation. Blinded key informant interviews were conducted in order of availability until no new themes emerged. Themes identified during the interviews were used to develop a Modified Delphi survey, which was electronically delivered via Survey Monkey. The trauma center need criteria were refined iteratively based on participant responses. Participants completed additional surveys until there was at least 80% agreement for each criterion.
RESULTS: Fourteen experts were recruited. Five participated in key informant interviews. A Modified Delphi survey was administered five times (four modifications based on the expert's responses). After the fifth round, there was at least 82% agreement on each criterion. The final definition included 10 time-specific indicators: major surgery, advanced airway, blood products, admission for spinal cord injury, thoracotomy, pericardiocentesis, cesarean delivery, intracranial pressure monitoring, interventional radiology, and in-hospital death.
CONCLUSION: We developed a consensus-based functional criterion standard definition of needing the resources of a trauma center, which may help to standardize field triage research and quality assurance in trauma systems as well as allow for cross study comparisons.
Author List
Lerner EB, Willenbring BD, Pirrallo RG, Brasel KJ, Cady CE, Colella MR, Cooper A, Cushman JT, Gourlay DM, Jurkovich GJ, Newgard CD, Salomone JP, Sasser SM, Shah MN, Swor RA, Wang SCAuthors
Mario R. Colella DO, MPH Professor in the Emergency Medicine department at Medical College of WisconsinDavid M. Gourlay MD Chief, Professor in the Surgery department at Medical College of Wisconsin
MESH terms used to index this publication - Major topics in bold
ConsensusEmergency Medical Services
Humans
Quality Indicators, Health Care
Trauma Centers
United States
