The effect of medical direction on trauma triage.

Effective field triage of trauma victims requires identification of patients at risk of dying and their rapid transport to hospitals capable of treating severe injuries. Identification of these patients at the accident scene can be difficult since prehospital personnel receive little training in structured triage decision making. The role of the physician in routine triage is disputed and his/her value has not been documented. This study explored the severity of injury of three groups of trauma patients triaged by different guidelines to a Level I urban trauma center. Results showed that with physician input in the triage process, patients chosen for helicopter transport to the trauma center had a significantly higher median level of injury severity than patients triaged to the trauma center without physician involvement. The results have implications for controlling overtriage of patients to trauma centers.