Student Presenter(s): Jae Moo Lee
Faculty Mentor: Stephen DiRusso
Department: Clinical Sciences
School/College: College of Osteopathic Medicine, Long Island

Current literature has not extensively studied the decision-making process of triaging lower-risk trauma patients in either the General Ward (GW) or Stepdown unit (SDU).

Admitted trauma patients with an age of 18-years or older at Level II Trauma Center in Bronx, NY, between 2010 and 2019 were identified. Burn patients, intensive care unit admission, and patients needing invasive ventilation were excluded. Multiple logistic regression models were used to identify predictors for triaging patients to either GW or SDU. Area Under the Curve (AUC) was identified to assess the performance of the model. Also, predicted probabilities of triaging patients to SDU were compared between GW and SDU patients.

Out of the total of 8442 trauma patients, 3523 were included: 2770 were triaged to GW, and 753 were triaged to SDU. Adjusting for patient characteristics, the AUC of the multivariable logistic model was 0.724. Patients who were inebriated (OR=1.70; 95%Cl 1.04- 2.78; p<0.001), NISS greater 15 (OR=2.46; 95%Cl 1.98-3.07; p<0.001), and higher comorbidity (OR=1.06; 95%Cl 1.03-1.09; p<0.001) had higher odds of being admitted to SDU. Gender and insurance status were insignificant. The median predicted probability to be admitted to SDU among GW and SDU patients was 0.15(0.10-0.25) and 0.28(0.16-0.41), respectively.

Lower-risk trauma patients are triaged based on patient and injury characteristics. However, there is wide variability. There is a need for evidence-based algorithms to triage.