Evidence for and impact of selective reporting of trauma triage mechanism criteria.

OBJECTIVE

To determine whether out-of-hospital care charts selectively report trauma triage criteria, and the impact of such documentation on triage guideline development.

METHODS

A special structured data instrument that requested the presence or absence of the American College of Surgeons (ACS) trauma triage criteria was completed by emergency medical services (EMS) personnel transporting victims of motor vehicle crashes. The standard written EMS report forms for a subset of 199 patients with at least 1 ACS trauma triage mechanism criterion were reviewed by the investigators. Outcome data were obtained from medical record review. The structured data instrument and the standard EMS report were compared for concordance. The impact of method of data collection on the ability of the ACS criteria to predict patient outcome was determined.

RESULTS

EMS reports and structured data instruments similarly noted the presence of anatomic, physiologic, and "other" trauma triage criteria (p > 0.07 for all individual comparisons). Most mechanism-of-injury criteria noted on the data instrument (pedestrian struck > 20 mph; crash speed > 20 mph; vehicle deformity; compartment intrusion; rollover; and ejection) were infrequently documented on the standard EMS report (median 28.5% noted, range 0-100%). Patients who had mechanism criteria noted on the EMS report were more likely to be admitted to the hospital (44% vs 13%; p = 0.006), to require major operative procedures (10% vs 0%; p = 0.005), and to have prolonged lengths of stay (26% vs 9%; p = 0.02) and injury severity scores > or = 16 (15% vs 3%; p = 0.03) than were patients who had mechanism criteria documented only on the structured data instrument.

CONCLUSIONS

In the authors' EMS system, standard EMS report documentation underreports ACS trauma triage mechanism criteria. This underreporting appears to bias outcome analysis in the direction of a worse outcome and more resource utilization. Reporting of mechanism-of-injury criteria improves with use of a structured data instrument.