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A consensus-based criterion standard for trauma center need

Lerner, E. Brooke PhD; Willenbring, Brian D. BA, EMT-B; Pirrallo, Ronald G. MD, MHSA; Brasel, Karen J. MD, MPH; Cady, Charles E. MD; Colella, M. Riccardo DO, MPH; Cooper, Arthur MD, MS; Cushman, Jeremy T. MD, MS, EMT-P; Gourlay, David M. MD; Jurkovich, Gregory J. MD; Newgard, Craig D. MD, MPH; Salomone, Jeffrey P. MD, NREMT-P; Sasser, Scott M. MD; Shah, Manish N. MD, MPH; Swor, Robert A. DO; Wang, Stewart C. MD, PhD

Journal of Trauma and Acute Care Surgery: April 2014 - Volume 76 - Issue 4 - p 1157–1163
doi: 10.1097/TA.0000000000000189
Current Opinion

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.

From the Department of Emergency Medicine (E.B.L., R.G.P., C.E.C., M.R.C.), Department of Surgery, Division of Trauma/Critical Care (K.J.B.), Department of Surgery, Division of Pediatric Surgery (D.M.G.), Medical College of Wisconsin (B.D.W.) Milwaukee, Wisconsin; Division of Pediatric Surgery, Department of Surgery, Columbia University Medical Center Affiliation at Harlem Hospital (A.C.), New York; and Department of Emergency Medicine, University of Rochester School of Medicine and Dentistry, University of Rochester (J.T.C., M.N.S.), Rochester, New York; Department of Surgery, Denver Health Medical Center (G.J.J.), Denver, Colorado; Department of Emergency Medicine, Oregon Health & Science University (C.D.N.), Portland, Oregon; Department of Surgery, Maricopa Medical Center (J.P.S.), Phoenix, Arizona; Department of Emergency Medicine, Emory University School of Medicine (S.M.S.), Atlanta, Georgia; Department of Emergency Medicine, William Beaumont Hospital (R.A.S.), Royal Oak; and Department of Surgery, Section of Acute Care Surgery, University of Michigan Health Systems (S.C.W.), Ann Arbor, Michigan.

Submitted: November 30, 2013, Revised: January 2, 2014, Accepted: January 2, 2014.

This study was p resented at the Society for Academic Emergency Medicine Annual Meeting, May 2013, in Atlanta, Georgia.

Address for reprints: E. Brooke Lerner, PhD, Department of Emergency Medicine, Medical College of Wisconsin, 9200 W Wisconsin Ave, Milwaukee, WI 53226; email:

© 2014 Lippincott Williams & Wilkins, Inc.