Triage

Chapter

Abstract

The process of triaging injured patients in the out-of-hospital setting is a critically important aspect of concentrating persons with serious injuries in major trauma centers, where previous research has demonstrated improved outcomes. Because the majority of seriously injured patients access acute care through 9-1-1 emergency medical services (EMS), an accurate and effective field process for getting the “right” patients to the “right” place is a vital aspect of regionalized trauma care. The current template for field trauma triage was developed more than two decades ago, with minor periodic revisions. These guidelines have been widely promoted and integrated into most US trauma systems. However, despite the importance of field triage and a large existing body of research, many triage issues remain poorly understood. This chapter provides a detailed evaluation of the existing trauma triage literature, the triage algorithm and its presumed accuracy, critical concepts integral to field triage, key limitations and gaps in existing triage research, unique populations, out-of-hospital cognitive reasoning in triage, and future directions.

Keywords

Dementia Expense 

References

  1. American College of Surgeons (1976). Optimal hospital resources for care of the seriously injured. Bulletin of the American College of Surgeons, 61:15–22.Google Scholar
  2. American College of Surgeons (1986): Hospital and prehospital resources for the optimal care of the injured patient. Chicago, IL: American College of Surgeons.Google Scholar
  3. American College of Surgeons (1987): Hospital and prehospital resources for the optimal care of the injured patient, Appendices A through J. Chicago, IL: American College of Surgeons.Google Scholar
  4. American College of Surgeons (1990): Resources for the optimal care of the injured patient. Chicago, IL: American College of Surgeons.Google Scholar
  5. American College of Surgeons (2006): Resources for the optimal care of the injured patient. Chicago, IL: American College of Surgeons.PubMedGoogle Scholar
  6. Baez, A. A., Lane, P. L., & Sorondo, B. (2003). System compliance with out-of-hospital trauma triage criteria. Journal of Trauma, 54, 344–351.PubMedGoogle Scholar
  7. Baxt, W. G., Jones, G., & Fortlage, D. (1990). The Trauma Triage Rule: A new, resource-based approach to the out-of-hospital identification of major trauma victims. Annals of Emergency Medicine, 19, 1401–1406.PubMedGoogle Scholar
  8. Baxt, W. G., & Upenieks, V. (1990). The lack of full correlation between the injury severity score and the resource needs of injured patients. Annals of Emergency Medicine, 19, 1396–1400.PubMedGoogle Scholar
  9. Bond, R. J., Kortbeek, J. B., & Preshaw, R. M. (1997). Field trauma triage: Combining mechanism of injury with the out-of-hospital index for an improved trauma triage tool. Journal of Trauma, 43, 283–287.PubMedGoogle Scholar
  10. Branas, C. C., MacKenzie, E. J., Williams, J. C., et al. (2005). Access to trauma centers in the United States. Journal of the American Medical Association, 293, 2626–2633.PubMedGoogle Scholar
  11. Burd, R. S., Jan, T. S., & Nair, S. S. (2007). Evaluation of the relationship between mechanism of injury and outcome in pediatric trauma. Journal of Trauma, 62, 1004–1014.PubMedGoogle Scholar
  12. Centers for Disease Control and Prevention. (2009). Guidelines for field triage of injured patients: Recommendations of the national expert panel on field triage. Morbidity and Mortality Weekly Report, 57, 1–35.Google Scholar
  13. Chan, B. S. H., Walker, P. J., & Cass, D. T. (1989). Urban trauma: An analysis of 1,116 paediatric cases. Journal of Trauma, 29, 1540–1547.PubMedGoogle Scholar
  14. Coates, B. M., Vavilala, M. S., Mack, C. D., et al. (2005). Influence of definition and location of hypotension on outcome following severe pediatric traumatic brain injury. Critical Care Medicine, 33, 2645–2650.PubMedCentralPubMedGoogle Scholar
  15. Cooper, A., Barlow, B., DiScala, C., et al. (1993). Efficacy of pediatric trauma care: Results of a population-based study. Journal of Pediatric Surgery, 28, 299–303.PubMedGoogle Scholar
  16. Cooper, M. E., Yarbrough, D. R., Zone-Smith, L., et al. (1995). Application of field triage guidelines by prehospital personnel: Is mechanism of injury a valid guideline for patient triage? American Surgeon, 61, 363–367.PubMedGoogle Scholar
  17. Cottington, E. M., Young, J. C., Shufflebarger, C. M., et al. (1988). The utility of physiologic status, injury site, and injury mechanism in identifying patients with major trauma. Journal of Trauma, 28, 305–311.PubMedGoogle Scholar
  18. Crawford, S. L., Tennstedt, S. L., & McKinlay, J. B. (1995). A comparison of analytic methods for non-random missingness of outcome data. Journal of Clinical Epidemiology, 48, 209–219.PubMedGoogle Scholar
  19. Croskerry, P. (2009). A universal model of diagnostic reasoning. Academic Medicine, 84, 1022–1028.PubMedGoogle Scholar
  20. Demetriades, D., Martin, M., Salim, A., et al. (2005). The effect of trauma center designation and trauma volume on outcome in specific severe injuries. Annals of Surgery, 242, 512–519.PubMedGoogle Scholar
  21. Eichelberger, M. R., Gotschall, C. S., Sacco, W. J., et al. (1989). A comparison of the trauma score, the revised trauma score, and the pediatric trauma score. Annals of Emergency Medicine, 18, 1053–1058.PubMedGoogle Scholar
  22. Engum, S. A., Mitchell, M. K., Scherer, L. R., et al. (2000). Prehospital triage in the injured pediatric patient. Journal of Pediatric Surgery, 35, 82–87.PubMedGoogle Scholar
  23. Esposito, T. J., Offner, P. J., Jurkovich, G. J., et al. (1995). Do out of hospital trauma center triage criteria identify major trauma victims? Archives of Surgery, 130, 171–176.PubMedGoogle Scholar
  24. Fishman, P. E., Shofer, F. S., Robey, J. L., et al. (2006). The impact of trauma activations on the care of emergency department patients with potential acute coronary syndromes. Annals of Emergency Medicine, 48, 347–353.PubMedGoogle Scholar
  25. Franklin, G. A., Boaz, P. W., Spain, D. A., et al. (2000). Prehospital hypotension as a valid indicator of trauma team activation. Journal of Trauma, 48, 1034–9.PubMedGoogle Scholar
  26. Fries, G. R., McCalla, G., Levitt, M. A., et al. (1994). A prospective comparison of paramedic judgment and the trauma triage rule in the prehospital setting. Annals of Emergency Medicine, 24, 885–889.PubMedGoogle Scholar
  27. Future of emergency care series: Emergency care for children, growing pains (2006a). Committee on the Future of Emergency Care in the United States Health System, Board on Health Care Services. Washington, DC: Institute of Medicine of the National Academies. The National Academy PressGoogle Scholar
  28. Future of emergency care series: Hospital-based emergency care, at the breaking point (2006b). Committee on the Future of Emergency Care in the United States Health System, Board on Health Care Services. Washington, DC: Institute of Medicine of the National Academies. The National Academy PressGoogle Scholar
  29. Gausche, M., Henderson, D. P., & Seidel, J. S. (1990). Vital signs as part of the prehospital assessment of the pediatric patient: A survey of paramedics. Annals of Emergency Medicine, 19, 173–8.PubMedGoogle Scholar
  30. Goldfarb, M. G., Bazzoli, G. J., & Coffey, R. M. (1996). Trauma systems and the costs of trauma care. Health Services Research, 31, 71–95.PubMedGoogle Scholar
  31. Gomez, D., Berube, M., Ziong, W., et al. (2010). Identifying targets for potential interventions to reduce rural trauma deaths: A population-based analysis. Journal of Trauma, 69, 633–9.Google Scholar
  32. Gray, A., Goyder, E. C., Goodacre, S. W., et al. (1997). Trauma triage: A comparison of CRAMS and TRTS in a UK population. Injury, 28, 97–101.PubMedGoogle Scholar
  33. Green, S. M. (2009). Trauma surgery: Discipline in crisis. Annals of Emergency Medicine, 54, 198–207.Google Scholar
  34. Hall, J. R., Reyes, H. M., & Meller, J. L. (1996). The outcome for children with blunt trauma is best at a pediatric trauma center. Journal of Pediatric Surgery, 31, 72–77.PubMedGoogle Scholar
  35. Hannan, E. L., Farrell, L. S., Cooper, A., et al. (2005). Physiologic trauma triage criteria in adult trauma patients: Are they effective in saving lives by transporting patients to trauma centers? Journal of the American College of Surgeons, 200, 584–592.PubMedGoogle Scholar
  36. Henry, M. C., Hollander, J. E., Alicandro, J. M., et al. (1996). Incremental benefit of individual American College of Surgeons trauma triage criteria. Academic Emergency Medicine, 3, 992–1000.PubMedGoogle Scholar
  37. Hoff, W. S., Tinkoff, G. H., Lucke, J. F., et al. (1992). Impact of minimal injuries on a level I trauma center. Journal of Trauma, 33, 408–412.PubMedGoogle Scholar
  38. Hsia, R. Y., Wang, E., Torres, H., et al. (2010). Disparities in trauma center access despite increasing utilization: Data from California, 1999 to 2006. Journal of Trauma, 68, 217–24.PubMedGoogle Scholar
  39. Hulka, F., Mullins, R. J., Mann, N. C., et al. (1997). Influence of a statewide trauma system on pediatric hospitalization and outcome. Journal of Trauma, 42, 514–519.PubMedGoogle Scholar
  40. Iserson, K. V., & Moskop, J. C. (2007). Triage in medicine, part I: Concept, history, and types. Annals of Emergency Medicine, 49, 275–281.PubMedGoogle Scholar
  41. Johnson, D. L., & Krishnamurthy, S. (1996). Send severely head-injured children to a pediatric trauma center. Pediatric Neurosurgery, 25, 309–314.PubMedGoogle Scholar
  42. Jurkovich, G. J., & Mock, C. (1999). Systematic review of trauma system effectiveness based on registry comparisons. Journal of Trauma, 47, S46–55.PubMedGoogle Scholar
  43. Kane, G., Engelhardt, R., Celentano, J., et al. (1985). Empirical development and evaluation of out of hospital trauma triage instruments. Journal of Trauma, 25, 482–9.PubMedGoogle Scholar
  44. Kaufmann, C. R., Maier, R. V., Rivara, F. P., et al. (1990). Evaluation of the pediatric trauma score. Journal of the American Medical Association, 263, 69–72.PubMedGoogle Scholar
  45. Knopp, R., Yanagi, A., Kallsen, G., et al. (1988). Mechanism of injury and anatomic injury as criteria for out of hospital trauma triage. Annals of Emergency Medicine, 17, 895–902.PubMedGoogle Scholar
  46. Laupacis, A., Sekar, N., & Stiell, I. G. (1997). Clinical prediction rules: A review and suggested modifications of methodological standards. Journal of the American Medical Association, 277, 488–494.PubMedGoogle Scholar
  47. Lerner, E. B. (2006). Studies evaluating current field triage: 1966–2005. Prehospital Emergency Care, 10, 303–306.PubMedGoogle Scholar
  48. Lerner, E. B., & Moscati, R. M. (2001). The golden hour: Scientific fact or medical “urban legend”? Academic Emergency Medicine, 8, 758–760.PubMedGoogle Scholar
  49. Lipsky, A. M., Gausche-Hill, M., Henneman, P. L., et al. (2006). Prehospital hypotension is a predictor of the need for an emergent, therapeutic operation in trauma patients with normal systolic blood pressure in the emergency department. Journal of Trauma, 61, 1228–33.PubMedGoogle Scholar
  50. Little, R. J. A., & Rubin, D. B. (2002). Statistical analysis with missing data (2nd ed.). New York: Wiley.Google Scholar
  51. Long, W. B., Bachulis, B. L., & Hynes, G. D. (1986). Accuracy and relationship of mechanisms of injury, trauma score, and injury severity score in identifying major trauma. American Journal of Surgery, 151, 581–584.PubMedGoogle Scholar
  52. Ma, M. H., MacKenzie, E. J., Alcorta, R., et al. (1999). Compliance with prehospital triage protocols for major trauma patients. Journal of Trauma, 46, 168–75.PubMedGoogle Scholar
  53. MacKenzie, E. J., Rivara, F. P., Jurkovich, G. J., et al. (2006). A national evaluation of the effect of trauma-center care on mortality. New England Journal of Medicine, 354, 366–378.PubMedGoogle Scholar
  54. MacKenzie, E. J., Weir, S., Rivara, F. P., et al. (2010). The value of trauma center care. Journal of Trauma, 69, 1–10.PubMedGoogle Scholar
  55. Mackersie, R. C. (2006). History of trauma field triage development and the American College of Surgeons criteria. Prehospital Emergency Care, 10, 287–294.PubMedGoogle Scholar
  56. Mann, N. C., MacKenzie, E., Teitelbaum, S. D., et al. (2005). Trauma system structure and viability in the current healthcare environment: A state-by-state assessment. Journal of Trauma, 58, 136–147.PubMedGoogle Scholar
  57. Mann, N. C., Mullins, R. J., & Hedges, J. R. (2001). Mortality among seriously injured patients treated in remote rural trauma centers before and after implementation of a statewide trauma system. Medical Care, 39, 643–653.Google Scholar
  58. Mann, N. C., Pinkney, K. A., Price, D. D., et al. (2002). Injury mortality following the loss of air medical support for rural inter-hospital transport. Academic Emergency Medicine, 9, 694–698.PubMedGoogle Scholar
  59. McConnell, K. J., Johnson, L. A., Arab, N., et al. (2007). The on-call crisis: A statewide assessment of the costs of providing on-call specialist coverage. Annals of Emergency Medicine, 49, 727–733.PubMedGoogle Scholar
  60. McConnell, K. J., Newgard, C. D., & Lee, R. (2008). Changes in the cost and management of emergency department on-call coverage: Evidence from a longitudinal statewide survey. Annals of Emergency Medicine, 52, 635–642.PubMedGoogle Scholar
  61. Moskop, J. C., & Iserson, K. V. (2007). Triage in medicine, part II: Underlying values and principles. Annals of Emergency Medicine, 49, 282–287.PubMedGoogle Scholar
  62. Mulholland, S. A., Gabbe, B. J., & Cameron, P. (2005). Is paramedic judgment useful in prehospital trauma triage? Injury, International Journal of the Care Injured, 36, 1298–1305.Google Scholar
  63. Mullins, R. J., & Mann, N. C. (1999). Population-based research assessing the effectiveness of trauma systems. Journal of Trauma, 47, S59–66.PubMedGoogle Scholar
  64. Mullins, R. J., Mann, N. C., Hedges, J. R., et al. (1998). Preferential benefit of implementation of a statewide trauma system in one of two adjacent states. Journal of Trauma, 44, 609–617.PubMedGoogle Scholar
  65. Mullins, R. J., Veum-Stone, J., Hedges, J. R., et al. (1996). Influence of a statewide trauma system on location of hospitalization and outcome of injured patients. Journal of Trauma, 40, 536–545.PubMedGoogle Scholar
  66. Mullins, R. J., Veum-Stone, J., Helfand, M., et al. (1994). Outcome of hospitalized injured patients after institution of a trauma system in an urban area. Journal of the American Medical Association, 271, 1919–1924.PubMedGoogle Scholar
  67. Nathens, A. B., Jurkovich, G. J., & Rivara, F. P. (2000). Effectiveness of state trauma systems in reducing injury-related mortality: A national evaluation. Journal of Trauma, 48, 25–30.PubMedGoogle Scholar
  68. Nathens, A. B., Maier, R. V., Brundage, S. I., et al. (2003). The effect of interfacility transfer on outcome in an urban trauma system. Journal of Trauma, 55, 444–449.PubMedGoogle Scholar
  69. Nayduch, D. A., Moylan, J., Rutledge, R., et al. (1991). Comparison of the ability of adult and pediatric trauma scores to predict pediatric outcome following major trauma. Journal of Trauma, 31, 452–8.PubMedGoogle Scholar
  70. Newgard, C. D., Cudnik, M., Warden, C. R., et al. (2007). The predictive value and appropriate ranges of prehospital physiological parameters for high-risk injured children. Pediatric Emergency Care, 23, 450–456.PubMedGoogle Scholar
  71. Newgard, C. D., & Haukoos, J. (2007). Missing data in clinical research – part 2: Multiple imputation. Academic Emergency Medicine, 14, 669–678.PubMedGoogle Scholar
  72. Newgard, C. D., Hedges, J. R., Diggs, B., et al. (2008). Establishing the need for trauma center care: Anatomic injury or resource use? Prehospital Emergency Care, 12, 451–458.PubMedGoogle Scholar
  73. Newgard, C. D., Hui, J., Griffin, A., et al. (2005). Prospective validation of a clinical decision rule to identify severely injured children at the scene of motor vehicle crashes. Academic Emergency Medicine, 12, 679–687.PubMedGoogle Scholar
  74. Newgard, C. D., Lewis, R. J., & Jolly, B. T. (2002). Use of out-of-hospital variables to predict severity of injury in pediatric patients involved in motor vehicle crashes. Annals of Emergency Medicine, 39, 481–491.PubMedGoogle Scholar
  75. Newgard, C. D., McConnell, K. J., & Hedges, J. R. (2006). Variability of trauma transfer practices among non-tertiary care hospital emergency departments. Academic Emergency Medicine, 13, 746–754.PubMedGoogle Scholar
  76. Newgard, C. D., McConnell, K. J., Hedges, J. R., et al. (2007). The benefit of higher level of care transfer of injured patients from non-tertiary care hospital emergency departments. Journal of Trauma, 63, 965–971.PubMedGoogle Scholar
  77. Newgard, C. D., Nelson, M. J., Kampp, M., et al. (2011). Out-of-hospital decision-making and factors influencing the regional distribution of injured patients in a trauma system. Journal of Trauma, 70, 1345–53.Google Scholar
  78. Newgard, C. D., Rudser, K., Atkins, D. L., et al. (2009). The availability and use of out-of-hospital physiologic information to identify high-risk injured children in a multisite, population-based cohort. Prehospital Emergency Care, 13, 420–31.PubMedCentralPubMedGoogle Scholar
  79. Newgard, C. D., Rudser, K., Hedges, J. R., et al. (2010). A critical assessment of the out-of-hospital trauma triage guidelines for physiologic abnormality. Journal of Trauma, 68, 452–62.PubMedCentralPubMedGoogle Scholar
  80. Newgard, C. D., Schmicker, R., Hedges, J. R., et al. (2010). Emergency medical services time intervals and survival in trauma: Assessment of the “Golden Hour” in a North American prospective cohort. Annals of Emergency Medicine, 55, 235–246.PubMedCentralPubMedGoogle Scholar
  81. Newgard C. D., Zive D, Holmes J. F., et al. (2012). A multi-site assessment of the ACSCOT field triage decision scheme for identifying seriously injured children and adults. Journal of American College of Surgeons (In Press).PubMedGoogle Scholar
  82. Nirula, R., Maier, R., Moore, E., et al. (2010). Scoop and run to the trauma center or stay and play at the local hospital: Hospital transfer’s effect on mortality. Journal of Trauma, 69, 595–601.PubMedGoogle Scholar
  83. Norcross, E. D., Ford, D. W., Cooper, M. E., et al. (1995). Application of American college of surgeons’ field triage guidelines by pre-hospital personnel. Journal of the American College of Surgeons, 181, 539–544.PubMedGoogle Scholar
  84. Phillips, J. A., & Buchman, T. G. (1993). Optimizing out of hospital triage criteria for trauma team alerts. Journal of Trauma, 34, 127–32.PubMedGoogle Scholar
  85. Phillips, S., Rond, P. C., Kelly, S. M., et al. (1996). The need for pediatric-specific triage criteria: Results from the Florida trauma triage study. Pediatric Emergency Care, 12, 394–398.PubMedGoogle Scholar
  86. Pointer, J. E., Levitt, M. A., Young, J. C., et al. (2001). Can paramedics using guidelines accurately triage patients? Annals of Emergency Medicine, 38, 268–77.PubMedGoogle Scholar
  87. Potoka, D. A., Schall, L. C., & Ford, H. R. (2001). Development of a novel age-specific pediatric trauma score. Journal of Pediatric Surgery, 36, 106–112.PubMedGoogle Scholar
  88. Pracht, E. E., Tepas, J. J., & Celso, B. G. (2007). Survival advantage associated with treatment of injury at designated trauma centers. Medical Care Research and Review, 64, 83–97.PubMedGoogle Scholar
  89. Pracht, E. E., Tepas, J. J., Langland-Orban, B., et al. (2008). Do pediatric patients with trauma in Florida have reduced mortality rates when treated in designated trauma centers? Journal of Pediatric Surgery, 43, 212–221.PubMedGoogle Scholar
  90. Qazi, K., Kempf, J. A., Christopher, N. C., et al. (1998). Paramedic judgment of the need for trauma team activation for pediatric patients. Academic Emergency Medicine, 5, 1002–1007.PubMedGoogle Scholar
  91. Resources for the Optimal Care of the Injured Patient (1993). Chicago, IL: American College of SurgeonsGoogle Scholar
  92. Resources for the Optimal Care of the Injured Patient (1999). Chicago, IL: American College of SurgeonsGoogle Scholar
  93. Resources for the Optimal Care of the Injured Patient (2006). Chicago, IL: American College of SurgeonsGoogle Scholar
  94. Rivara, F. P., Nathens, A. B., Jurkovich, G. J., et al. (2006). Do trauma centers have the capacity to respond to disasters? Journal of Trauma, 61, 949–953.PubMedGoogle Scholar
  95. Sampalis, J. S., Denis, R., Frechette, P., et al. (1997). Direct transport to tertiary trauma centers versus transfer from lower level facilities – impact on mortality and morbidity among patients with major trauma. Journal of Trauma, 43, 288–296.PubMedGoogle Scholar
  96. Sampalis, J. S., Denis, R., Lavoie, A., et al. (1999). Trauma care regionalization: A process-outcome evaluation. Journal of Trauma, 46, 565–581.PubMedGoogle Scholar
  97. Sampalis, J. S., Lavoie, A., Williams, J. I., et al. (1993). Impact of on-site care, prehospital time, and level of in-hospital care on survival in severely injured patients. Journal of Trauma, 34, 252–261.PubMedGoogle Scholar
  98. Scheetz, L. J. (2003). Effectiveness of prehospital trauma triage guidelines for the identification of major trauma in elderly motor vehicle crash victims. Journal of Emergency Nursing, 29, 109–115.PubMedGoogle Scholar
  99. Shafi, S., Nathens, A. B., Elliott, A. C., et al. (2006). Effect of trauma systems on motor vehicle occupant mortality: A comparison between states with and without a formal system. Journal of Trauma, 61, 1374–8.PubMedGoogle Scholar
  100. Shatney, C. H., & Sensaki, K. (1994). Trauma team activation for “mechanism of injury” blunt trauma victims: Time for a change? Journal of Trauma, 37, 275–281.PubMedGoogle Scholar
  101. Simmons, E., Hedges, J. R., Irwin, L., et al. (1995). Paramedic injury severity perception can aid trauma triage. Annals of Emergency Medicine, 26, 461–468.PubMedGoogle Scholar
  102. Simon, B. J., Legere, P., Emhoff, T., et al. (1994). Vehicular trauma triage by mechanism: Avoidance of the unproductive evaluation. Journal of Trauma, 37, 645–649.PubMedGoogle Scholar
  103. Smith, J. S., & Bartholomew, M. J. (1990). Trauma index revisited: A better triage tool. Critical Care Medicine, 18, 174–180.PubMedGoogle Scholar
  104. Steele, R., Gill, M., Green, S. M., et al. (2007). Do the American College of Surgeons’ “Major Resuscitation” trauma triage criteria predict emergency operative management? Annals of Emergency Medicine, 50, 1–6.PubMedGoogle Scholar
  105. Stiell, I. G., & Wells, G. A. (1999). Methodologic standard for the development of clinical decision rules in emergency medicine. Annals of Emergency Medicine, 33, 437–447.PubMedGoogle Scholar
  106. Sun, B. C., Mohanty, S. A., Weiss, R., et al. (2006). Effects of hospital closures and hospital characteristics on emergency department ambulance diversion, Los Angeles County, 1998 to 2004. Annals of Emergency Medicine, 47, 309–316.PubMedGoogle Scholar
  107. Tepas, J. J., Ramenofsky, M. L., Mollit, D. L., et al. (1988). The pediatric trauma score as a predictor of injury severity: An objective assessment. Journal of Trauma, 28, 425–429.PubMedGoogle Scholar
  108. The EAST Practice Management Guidelines Work Group (2010). Practice management guidelines for the appropriate triage of the victim of trauma. Eastern Association for the Surgery of TraumaGoogle Scholar
  109. Todd, S. R., Arthur, M., Newgard, C., et al. (2004). Hospital factors associated with splenectomy for splenic injury: A national perspective. Journal of Trauma, 57, 1065–1071.PubMedGoogle Scholar
  110. Utter, G. H., Maier, R. V., Rivara, F. P., et al. (2006). Inclusive trauma systems: Do they improve triage or outcomes of the severely injured? Journal of Trauma, 60, 529–35.PubMedGoogle Scholar
  111. Van Der Heijden, G. J. M. G., Donders, A. R. T., Stijnen, T., et al. (2006). Imputation of missing values is superior to complete case analysis and the missing-indicator method in multivariable diagnostic research: A clinical example. Journal of Clinical Epidemiology, 59, 1102–9.PubMedGoogle Scholar
  112. Vassar, M. J., Holcroft, J. J., Knudson, M. M., et al. (2003). Fractures in access to and assessment of trauma systems. Journal of the American College of Surgeons, 197, 717–725.PubMedGoogle Scholar
  113. Wang, N. E., Saynina, O., Kuntz-Duriseti, K., et al. (2008). Variability in pediatric utilization of trauma facilities in California: 1999 to 2005. Annals of Emergency Medicine, 52, 607–615.PubMedGoogle Scholar
  114. West, J. G., Murdock, M. A., Baldwin, L. C., et al. (1986). A method for evaluating field triage criteria. Journal of Trauma, 26, 655–9.PubMedGoogle Scholar
  115. Young, J. S., Bassam, D., Cephas, G. A., et al. (1998). Inter-hospital versus direct scene transfer of major trauma patients in a rural trauma system. American Surgeon, 64, 88–91.PubMedGoogle Scholar
  116. Zechnich, A. D., Hedges, J. R., Spackman, K., et al. (1995). Applying the trauma triage rule to blunt trauma patients. Academic Emergency Medicine, 2, 1043–1052.PubMedGoogle Scholar

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© Springer Science+Business Media, LLC 2012

Authors and Affiliations

  1. 1.Department of Emergency Medicine, Center for Policy and Research in Emergency MedicineOregon Health and Science UniversityPortlandUSA

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