Disparities in Timing of Trauma Consultation: A Trauma Registry Analysis of Patient and Injury Factors

Paolo de Angelis, Elinore J. Kaufman, Philip S. Barie, Mayur Narayan, Kira Smith, Robert J. Winchell

Research output: Contribution to journalArticle

Abstract

Background: Efficient trauma systems rely on field and emergency department (ED) personnel to triage patients to the appropriate level of care. Undertriage puts patients at risk, whereas overtriage results in system strain. Although much research has focused on prehospital triage, little is known about trauma triage processes within the ED. We investigated the timing of trauma consultation in the ED of a level I trauma center. We hypothesized that patient characteristics and injury type would be associated with time to consultation, with women, Black patients, older patients, and those with head and torso injuries experiencing longer time to consult. Materials and methods: Patients aged ≥18 y referred to the trauma service via consultation were recruited retrospectively. Bivariable and multivariable negative binomial regressions were used to assess the association between patient and injury characteristics and time to consult. We used multivariable logistic regression adjusted for patient and injury characteristics to assess for association between time to consult and mortality and length of stay. Results: Among 588 adult consult patients, median time to consult was 177 min (interquartile range 106-265). In multivariable analysis, Black patients had longer time to consult (incidence rate ratio [IRR] 1.33, 95% confidence interval [CI] 1.10, 1.60) as did women (IRR 1.15, 95% CI 1.02, 1.29). Head injury was associated with shorter time to consult (IRR 0.81, 95% CI 0.71, 0.92). Time to consult was not associated with mortality or length of stay. Conclusions: Patient demographics and injury characteristics influenced the timing of trauma consultation. More robust criteria for equitable evaluation of patients are needed to eliminate disparities, prevent delays, and streamline care.

Original languageEnglish (US)
Pages (from-to)357-362
Number of pages6
JournalJournal of Surgical Research
Volume242
DOIs
StatePublished - Oct 1 2019
Externally publishedYes

Fingerprint

Registries
Referral and Consultation
Wounds and Injuries
Triage
Hospital Emergency Service
Confidence Intervals
Craniocerebral Trauma
Length of Stay
Incidence
Torso
Mortality
Trauma Centers
Logistic Models
Demography

Keywords

  • Disparities
  • Gender
  • Race
  • Trauma consult
  • Trauma triage

ASJC Scopus subject areas

  • Surgery

Cite this

Disparities in Timing of Trauma Consultation : A Trauma Registry Analysis of Patient and Injury Factors. / de Angelis, Paolo; Kaufman, Elinore J.; Barie, Philip S.; Narayan, Mayur; Smith, Kira; Winchell, Robert J.

In: Journal of Surgical Research, Vol. 242, 01.10.2019, p. 357-362.

Research output: Contribution to journalArticle

de Angelis, Paolo ; Kaufman, Elinore J. ; Barie, Philip S. ; Narayan, Mayur ; Smith, Kira ; Winchell, Robert J. / Disparities in Timing of Trauma Consultation : A Trauma Registry Analysis of Patient and Injury Factors. In: Journal of Surgical Research. 2019 ; Vol. 242. pp. 357-362.
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abstract = "Background: Efficient trauma systems rely on field and emergency department (ED) personnel to triage patients to the appropriate level of care. Undertriage puts patients at risk, whereas overtriage results in system strain. Although much research has focused on prehospital triage, little is known about trauma triage processes within the ED. We investigated the timing of trauma consultation in the ED of a level I trauma center. We hypothesized that patient characteristics and injury type would be associated with time to consultation, with women, Black patients, older patients, and those with head and torso injuries experiencing longer time to consult. Materials and methods: Patients aged ≥18 y referred to the trauma service via consultation were recruited retrospectively. Bivariable and multivariable negative binomial regressions were used to assess the association between patient and injury characteristics and time to consult. We used multivariable logistic regression adjusted for patient and injury characteristics to assess for association between time to consult and mortality and length of stay. Results: Among 588 adult consult patients, median time to consult was 177 min (interquartile range 106-265). In multivariable analysis, Black patients had longer time to consult (incidence rate ratio [IRR] 1.33, 95{\%} confidence interval [CI] 1.10, 1.60) as did women (IRR 1.15, 95{\%} CI 1.02, 1.29). Head injury was associated with shorter time to consult (IRR 0.81, 95{\%} CI 0.71, 0.92). Time to consult was not associated with mortality or length of stay. Conclusions: Patient demographics and injury characteristics influenced the timing of trauma consultation. More robust criteria for equitable evaluation of patients are needed to eliminate disparities, prevent delays, and streamline care.",
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