Prediction of sepsis within 24 hours at the triage stage in emergency departments using machine learning

BACKGROUND:Sepsis is one of the main causes of mortality in intensive care units(ICUs).Early prediction is critical for reducing injury.As approximately 36%of sepsis occur within 24 h after emergency department(ED)admission in Medical Information Mart for Intensive Care(MIMIC-IV),a prediction system for the ED triage stage would be helpful.Previous methods such as the quick Sequential Organ Failure Assessment(qSOFA)are more suitable for screening than for prediction in the ED,and we aimed to fi nd a light-weight,convenient prediction method through machine learning.METHODS:We accessed the MIMIC-IV for sepsis patient data in the EDs.Our dataset comprised demographic information,vital signs,and synthetic features.Extreme Gradient Boosting(XGBoost)was used to predict the risk of developing sepsis within 24 h after ED admission.Additionally,SHapley Additive exPlanations(SHAP)was employed to provide a comprehensive interpretation of the model's results.Ten percent of the patients were randomly selected as the testing set,while the remaining patients were used for training with 10-fold cross-validation.RESULTS:For 10-fold cross-validation on 14,957 samples,we reached an accuracy of 84.1%±0.3%and an area under the receiver operating characteristic(ROC)curve of 0.92±0.02.The model achieved similar performance on the testing set of 1,662 patients.SHAP values showed that the fi ve most important features were acuity,arrival transportation,age,shock index,and respiratory rate.CONCLUSION:Machine learning models such as XGBoost may be used for sepsis prediction using only a small amount of data conveniently collected in the ED triage stage.This may help reduce workload in the ED and warn medical workers against the risk of sepsis in advance.

Application of Mobile Technology and Information Management in Emergency Pre- Examination and Triage

The primary objective of emergency pre-examination and triage is to provide the most appropriate clinical service to patients with acute and critical illnesses while ensuring the optimal utilization of limited medical resources.With the advancement of medical information technology,mobile technology,and information management,these features have been gradually incorporated into emergency pre-examination and triage and have shown promising outcomes.In this article,the benefits of implementing mobile technology and the current status of integrated information management to provide a reference for the future development and enhancement of emergency pre-examination and triage are reviewed.

Triage and Risk Concept: Application Proposal for Pre-Hospital Emergencies in a Psychiatric Ambulance in the City of Buenos Aires

The heterogeneity of clinical presentations in psychiatric emergencies creates difficulties in the response by interdisciplinary Mental Health teams. This is aggravated and difficult when the care is carried out on public roads or the patient’s home, that is, it is a pre-hospital context. Our Psychiatric Emergency Hospital, located in the City of Buenos Aires, provides pre-hospital care with a psychiatric ambulance, which is then referred to general hospitals or other health system providers. Not all effectors in the network have the same resources and, at the time of the emergency, the reasons for consultation such as the patient’s clinic are heterogeneous and require the greatest effectiveness in the intervention that is taken. The triage system is a resource that allows the systematization of approaches against the multiplicity of reasons for consultation and presentation of mental pathologies in the emergency room, in addition to providing greater effectiveness in interventions, homogeneity for the health system and consensus among the health effectors. Framed in the Mental Health Law, and especially in the concept of risk, a triage proposal was designed for pre-hospital interventions by the psychiatric ambulance dependent on Hospital Alvear and under current legal regulations with the aim of homogenizing care and referrals with the highest rate of effectiveness to provide quality interdisciplinary medicine.

A Qualitative Study of the Triage of Patients with Non-Traumatic Acute Abdomen

Objective: To explore the work experience of medical staff in the emergency department of a general hospital in the triage of patients with non-traumatic acute abdomen to formulate corresponding intervention measures and branch evaluation tools. Methods: With descriptive phenomenology as the research method, semi-structured interviews were conducted with the medical staff in a tertiary hospital in Nanjing from February 1st to 10th, 2023, and Colaizzi seven-step analysis was used to analyze the data. Results: A total of 17 emergency medical staff were interviewed in this study. Four themes were derived from the analysis of the data: the etiology of acute abdomen is complex, so it is difficult to categorize them: acute abdomen requires immediate treatment, but the treat will be delayed if the categorization is inaccurate;the high pressure of nurses and the accuracy in categorizing the patients are problems that should be addressed. Conclusion: The categorization of patients with non-traumatic acute abdomen is challenging. Therefore, it is necessary to carry out corresponding intervention and formulate appropriate departmental evaluation tools to improve the accuracy of categorization of patients with acute abdomen.

基于Document Triage的TF-IDF算法的改进

针对TF-IDF算法在加权时没有考虑特征词本身在文档中重要度的问题,提出利用用户阅读时的阅读行为来改进TF-IDF。将Document Triage引入到TF-IDF中,利用IPM收集用户阅读中行为的相关信息,计算文档评分。由于用户的标注内容往往是文章的重要内容,或者反映了用户的兴趣。因此,赋予用户标注词项更大的权重,将文档评分和用户的标注信息等作为因子引入到TF-IDF中,设计出改进的加权算法DT-TF-IDF。实验结果表明,相对传统TF-IDF算法,DT-TF-IDF的查全率、查准率,以及查准率和查全率的调和均值都有了一定的提高。DT-TF-IDF算法比传统TF-IDF算法更加有效,提高了文本相似度计算的准确性。

Accuracy of triage strategies for human papillomavirus DNA-positive women in low-resource settings:A cross-sectional study in China

Objective： CareHPV is a human papillomavirus （HPV） DNA test for low-resource settings （LRS）. This study assesses optimum triage strategies for careHPV-positive women in LRS. Methods： A total of 2,530 Chinese women were concurrently screened for cervical cancer with visual inspection with acetic acid （VIA）, liquid-based cytology and HPV testing by physician- and self-collected careHPV, and physician-collected Hybrid Capture 2 （HC2）. Screen-positive women were referred to colposcopy with biopsy and endocervical curettage as necessary. HPV-positivity was defined as _〉1.0 relative light units/cutoff （RLU/CO） for both careHPV and HC2. Primary physician-HC2, physician-careHPV and self-careHPV and in sequential screening with cytology, VIA, or increased HPV test-positivity performance, stratified by age, were assessed for cervical intraepithelial neoplasia （CIN） grade 2/3 or worse （CIN2/3＋） detection. Results： The sensitivities and specificities of primary HPV testing for CIN2＋ were： 83.8%, 88.1% for physician- careHPV; 72. 1%, 88.2% for self-careHPV; and 97.1%, 86.0% for HC2. Physician-careHPV test-positive women with VIA triage had a sensitivity of 30.9% for CIN2＋ versus 80.9% with cytology triage. Self-careHPV test- positive women with VIA triage was 26.5% versus 66.2 % with cytology triage. The sensitivity of HC2 test-positive women with VIA triage was 38.2 % versus 92.6% with cytology triage. The sensitivity of physician-careHPV testing for CIN2＋ decreased from 83.8% at _〉1.0 RLU/CO to 72.1% at _〉10.00 RLU/CO, while the sensitivity of self- careHPV testing decreased from 72.1% at _〉1.0 RLU/CO to 32.4% at _〉10.00 RLU/CO; similar trends were seen with age-stratification. Conclusions： VIA and cytology triage improved specificity for CIN2/3 than no triage. Sensitivity with VIA triage was unsuitable for a mass-screening program. VIA provider training might improve this strategy. Cytology triage could be feasible where a high-quality cytology program exists. Triage of HPV test-positive women by increased test positivity cutoff adds another LRS triage option.

Comparison between Emergency Severity Index and Heart Failure Triage Scale in heart failure patients: A randomized clinical trial

BACKGROUND:It is not clear whether Emergency Severity Index(ESI)is valid to triage heart failure(HF)patients and if HF patients benefi t more from a customized triage scale or not.The aim of study is to compare the effect of Heart Failure Triage Scale(HFTS)and ESI on mistriage among patients with HF who present to the emergency department(ED).METHODS:A randomized clinical trial was conducted from April to June 2017.HF patients with dyspnea were randomly assigned to HFTS or ESI groups.Triage level,used resources and time to electrocardiogram(ECG)were compared between both groups among HF patients who were admitted to coronary care unit(CCU),cardiac unit(CU)and discharged patients from the ED.Content validity was examined using Kappa designating agreement on relevance(K*).Reliability of both scale was evaluated using inter-observer agreement(Kappa).RESULTS:Seventy-three and 74 HF patients were assigned to HFTS and ESI groups respectively.Time to ECG in HFTS group was signifi cantly shorter than that of ESI group(2.05 vs.16.82 minutes).Triage level between HFTS and ESI groups was signifi cantly different among patients admitted to CCU(1.0 vs.2.8),cardiac unit(2.26 vs.3.06)and discharged patients from the ED(3.53 vs.2.86).Used resources in HFTS group was significantly different among triage levels(H=25.89;df=3;P<0.001).CONCLUSION:HFTS is associated with less mistriage than ESI for triaging HF patients.It is recommended to make use of HFTS to triage HF patients in the ED.

TriAGe+评分对头晕患者脑卒中的诊断价值研究

目的探讨TriAGe+评分对头晕患者脑卒中的诊断价值。方法选取2014年2月—2017年8月于安徽医科大学附属宿州医院就诊的1 437例以头晕为主诉的患者为研究对象,根据最终是否确诊为脑卒中分为非脑卒中组1 300例和脑卒中组137例。根据TriAGe+评分结果分为4组:极高危组(10~17分)、高危组(8~9分)、中危组(5~7分)及低危组(0~4分),比较4组患者脑卒中发生率;比较脑卒中组和非脑卒中组临床资料的不同;采用Logistic逐步回归分析头晕患者发生脑卒中的影响因素;采用受试者工作特征(ROC)曲线比较TriAGe+和ABCD2评分对头晕患者脑卒中的诊断价值。结果 1 437例头晕患者最后确诊为脑卒中者137例(9.5%)。非脑卒中组和脑卒中组性别、入院时血压、有无肢体无力或言语障碍、头晕持续时间、头晕有无诱发因素、头晕类型、脑干或小脑功能障碍、头晕及迷路或前庭疾病病史、糖尿病病史、高血压病史、心房颤动病史比较,差异有统计学意义(P<0.05);年龄比较,差异无统计学意义(P>0.05);Logistic逐步回归分析结果显示,性别、入院时血压、有无肢体无力、有无言语障碍、头晕持续时间、头晕有无诱发因素、头晕类型、脑干或小脑功能障碍、头晕及迷路或前庭疾病病史、糖尿病病史、高血压病史、心房颤动病史是头晕患者发生脑卒中的影响因素(P<0.05)。极高危组(10~17分)、高危组(8~9分)、中危组(5~7分)及低危组(0~4分)脑卒中发生率分别为65.5%(57/87)、27.0%(51/189)、5.8%(23/394)及0.8%(6/767),4组间比较,差异有统计学意义(P<0.05);4组间两两比较,差异均有统计学意义(P<0.008 3)。TriAGe+评分、ABCD2评分诊断头晕患者发生脑卒中的ROC曲线下面积分别为0.890[95%CI(0.866,0.914)]、0.806[95%CI(0.769,0.843)],两者比较,差异有统计学意义(P<0.001)。TriAGe+评分为10分时,对应的灵敏度为0.834,特异度为0.727,约登指数为0.561。结论 TriAGe+评分有助于快速识别主诉为头晕的脑卒中患者。

DeepTriage:一种基于深度学习的软件缺陷自动分配方法

在软件开发和维护过程中,缺陷修复工作有一项必不可少的任务,那就是缺陷分配.在大规模的软件项目中,基于文本分类的自动分配技术已被用于提高缺陷分配的效率,从而减少人工分配的等待时间和成本.考虑到缺陷报告文本内容的复杂性,本文提出了一种基于深度学习的缺陷自动分配方法,在词向量化后通过卷积神经网络对缺陷报告文本进行特征提取,然后完成分类任务.在Eclipse和Mozilla两个数据集上的结果表明,与传统的支持向量机和基于递归神经网络的方法相比,文本所提方法在准确率指标上均优于上述基准方法,而且多层平行的卷积神经网络结构比单层的卷积神经网络结构在预测效果上更好.

The reliability of the Australasian Triage Scale:a meta-analysis

BACKGROUND: Although the Australasian Triage Scale(ATS) has been developed two decades ago, its reliability has not been def ined; therefore, we present a meta-analyis of the reliability of the ATS in order to reveal to what extent the ATS is reliable.DATA SOURCES: Electronic databases were searched to March 2014. The included studies were those that reported samples size, reliability coefficients, and adequate description of the ATS reliability assessment. The guidelines for reporting reliability and agreement studies(GRRAS) were used. Two reviewers independently examined abstracts and extracted data. The effect size was obtained by the z-transformation of reliability coefficients. Data were pooled with random-effects models, and meta-regression was done based on the method of moment's estimator.RESULTS: Six studies were included in this study at last. Pooled coefficient for the ATS was substantial 0.428(95%CI 0.340–0.509). The rate of mis-triage was less than fifty percent. The agreement upon the adult version is higher than the pediatric version.CONCLUSION: The ATS has shown an acceptable level of overall reliability in the emergency department, but it needs more development to reach an almost perfect agreement.

Validation of different pediatric triage systems in the emergency department

BACKGROUND: Triage system in children seems to be more challenging compared to adults because of their different response to physiological and psychosocial stressors. This study aimed to determine the best triage system in the pediatric emergency department.METHODS: This was a prospective observational study. This study was divided into two phases. The fi rst phase determined the inter-rater reliability of fi ve triage systems: Manchester Triage System(MTS), Emergency Severity Index(ESI) version 4, Pediatric Canadian Triage and Acuity Scale(CTAS), Australasian Triage Scale(ATS), and Ramathibodi Triage System(RTS) by triage nurses and pediatric residents. In the second phase, to analyze the validity of each triage system, patients were categorized as two groups, i.e., high acuity patients(triage level 1, 2) and low acuity patients(triage level 3, 4, and 5). Then we compared the triage acuity with actual admission.RESULTS: In phase I, RTS illustrated almost perfect inter-rater reliability with kappa of 1.0(P<0.01). ESI and CTAS illustrated good inter-rater reliability with kappa of 0.8–0.9(P<0.01). Meanwhile, ATS and MTS illustrated moderate to good inter-rater reliability with kappa of 0.5–0.7(P<0.01). In phase II, we included 1 041 participants with average age of 4.7±4.2 years, of which 55% were male and 45% were female. In addition 32% of the participants had underlying diseases, and 123(11.8%) patients were admitted. We found that ESI illustrated the most appropriate predicting ability for admission with sensitivity of 52%, specifi city of 81%, and AUC 0.78(95%CI 0.74–0.81).CONCLUSION: RTS illustrated almost perfect inter-rater reliability. Meanwhile, ESI and CTAS illustrated good inter-rater reliability. Finally, ESI illustrated the appropriate validity for triage system.

Effect of a triage course on quality of rating triage codes in a group of university nursing students:a before-after observational study

BACKGROUND:Most current triage tools have been tested among hospital nurses groups but there are not similar studies in university setting.In this study we analyzed if a course on a new fourlevel triage model,triage emergency method(TEM),could improve the quality of rating in a group of nursing students.METHODS:This observational study was conducted with paper scenarios at the University of Parma,Italy.Fifty students were assigned a triage level to 105 paper scenarios before and after a course on triage and TEM.We used weighted kappa statistics to measure the inter-rater reliability of TEM and assessed its validity by comparing the students' predictions with the triage code rating of a reference standard(a panel of five experts in the new triage method).RESULTS:Inter-rater reliability was K=0.42(95%Cl:0.37-0.46) before the course on TEM,and K=0.61(95%CI:0.56-0.67) after.The accuracy of students' triage rating for the reference standard triage code was good:81%(95%Cl:71-90).After the TEM course,the proportion of cases assigned to each acuity triage level was similar for the student group and the panel of experts.CONCLUSION:Among the group of nursing students,a brief course on triage and on a new inhospital triage method seems to improve the quality of rating codes.The new triage method shows good inter-rater reliability for rating triage acuity and good accuracy in predicting the triage code rating of the reference standard.

Development and application of triage and evacuation equipment for casualties at sea

Traditional triage cannot meet the needs of modern warfare. This paper describes the design of triage and evacuation equipment for casualties at sea that can quickly address mass-casualty triage and store and transmit information during battlefield treatment and medical evacuation. This equipment consists of a high-capacity medical information card, a simulated patient generator, a triage classifier and a multifunctional airbag triage vest.

p16/Ki-67 dual-stained cytology used for triage in cervical cancer opportunistic screening

Objective:To evaluate the efficiency of p16/Ki-67 dual stain used as a triage in cervical cancer screening.Methods:In this study,we did 468 p16/Ki-67 dual stain in human papillomavirus(HPV)16/18-positive or 12 other high-risk HPV(OHR-HPV)positive Thinprep cytologic test(TCT)atypical squamous cells of undetermined significance(ASCUS)/lower-grade squamous intraepithelial lesion(LSIL)women.We evaluated the sensitivity,specificity,positive predictive value(PPV)and negative predictive value(NPV)of the triage test.Results:The sensitivity,specificity,PPV and NPV of p16/Ki-67 dual stain in HPV 16/18-positive women were91.5%/68.4%,77.0%/75.0%,73.9%/59.1%and 92.8%/81.8%.In 12 OHR-HPV positive TCT ASCUS/LSIL women,the results were 79.1%/95.0%,88.5%/66.7%,88.5%/70.4%and 89.2%/94.1%.The risk of precancerous lesions in p16/Ki-67 dual stain positive cases was much higher than before,and the negative cases had lower risk.Besides,there was no cervical intraepithelial neoplasia(CIN)III case missed after triaged by p16/Ki-67 dual-stained cytology.In p16/Ki-67 dual-stained cytology positive women with benign pathology or CIN I,the 1-year progression rate is 20.5%and in p16/Ki-67 dual-stained cytology negative women,the 1-year progression rate is5.6%.Conclusions:hr-HPV genotyping test plays an important role in cervical cancer screening.p16/Ki-67 dual stain may be a promising triage test.As for chronic cervicitis or CIN I patients,a positive p16/Ki-67 dual-stained cytology suggests a high risk in progression and need to be followed up closely.

Evaluation of triage strategies for high-risk human papillomavirus-positive women in cervical cancer screening:A multicenter randomized controlled trial in different resource settings in China

Objective:We aimed to evaluate the effectiveness of different triage strategies for high-risk human papillomavirus(hrHPV)-positive women in primary healthcare settings in China.Methods:This study was undertaken in 11 rural and 9 urban sites.Women aged 35-64 years old were enrolled.HrHPV-positive women were randomly allocated to liquid-based cytology(LBC),visual inspection with acetic acid and Lugol’s iodine(VIA/VILI)(rural only)triage,or directly referred to colposcopy(direct COLP).At 24 months,hrHPV testing,LBC and VIA/VILI were conducted for combined screening.Results:In rural sites,1,949 hrHPV-positive women were analyzed.A total of 852,218 and 480 women were randomly assigned to direct COLP,LBC and VIA/VILI.At baseline,colposcopy referral rates of LBC or VIA/VILI triage could be reduced by 70%-80%.LBC(n=3 and n=7)or VIA/VILI(n=8 and n=26)could significantly decrease the number of colposcopies needed to detect one cervical intraepithelial neoplasia(CIN)2 or worse and CIN3+compared with direct COLP(n=14 and n=23).For the 24-month cumulative detection rate of CIN2+,VIA/VILI triage was 0.50-fold compared with LBC triage and 0.46-fold with the direct COLP.When stratified by age,baseline LBC triage+performed best(P<0.001),peaking among women aged 35-44 years(Ptrend=0.002).In urban sites,1,728 women were hrHPV genotyping test positive.A total of 408,571 and 568women were randomly assigned to direct COLP for HPV16/18+,direct COLP for other hrHPV subtypes+,and LBC triage for other hrHPV subtypes+.LBC(n=12 and n=31)significantly decreased the number of colposcopies needed to detect one CIN2+and CIN3+compared with direct COLP(n=14 and n=44).HPV16/18+increased the 24-month cumulative detection rate of CIN2+(17.89%,P<0.001).Conclusions:LBC triage for hrHPV-positive women in rural settings and direct COLP for HPV16/18+women and LBC triage for other hrHPV subtype+women in urban settings might be feasible strategies.

Bombings specific triage(Bost Tool) tool and its application by healthcare professionals

BACKGROUND: Bombing is a unique incident which produces unique patterns, multiple and occult injuries. Death often is a result of combined blast, ballistic and thermal effect injuries. Various natures of injury, self referrals and arrival by private transportation may lead to "wrong triage" in the emergency department. In India there has been an increase in incidence of bombing in the last 15 years. There is no documented triage tool from the National Disaster Management Authority of India for Bombings. We have tried to develop an ideal bombing specific triage tool which will guide the right patients to the right place at the right time and save more lives.METHODS: There are three methods of studying the triage tool: 1) real disaster; 2) mock drill; 3) table top exercise. In this study, a table top exercise method was selected. There are two groups, each consisting of an emergency physician, a nurse and a paramedic.RESULTS: By using the proportion test, we found that correct triaging was significantly different(P=0.005) in proportion between the two groups: group B(80%) with triage tool performed better in triaging the bomb blast victims than group A(50%) without the bombing specific triage tool performed.CONCLUSION: Development of bombing specific triage tool can reduce under triaging.

Management and implementation strategies of pre-screening triage in children during coronavirus disease 2019 pandemic in Guangzhou, China

BACKGROUND Emerging infectious diseases are a constant threat to the public’s health and health care systems around the world.Coronavirus disease 2019(COVID-2019),which was defined by the World Health Organization as pandemic,has rapidly emerged as a global health threat.Outbreak evolution and prevention of international implications require substantial flexibility of frontline health care facilities in their response.AIM To explore the effect of the implementation and management strategy of prescreening triage in children during COVID-19.METHODS The standardized triage screening procedures included a standardized triage screening questionnaire,setup of pre-screening triage station,multi-point temperature monitoring,extensive screenings,and two-way protection.In order to ensure the implementation of the pre-screening triage,the prevention and control management strategies included training,emergency exercise,and staff protection.Statistical analysis was performed on the data from all the children hospitalized from January 20,2020 to March 20,2020 at solstice during the pandemic period.Data were obtained from questionnaires and electronic medical record systems.RESULTS A total of 17561 children,including 2652 who met the criteria for screening,192 suspected cases,and two confirmed cases without omission,were screened from January 20,2020 to March 20,2020 at solstice during the pandemic period.There was zero transmission of the infection to any medical staff.CONCLUSION The effective strategies for pre-screening triage have an essential role in the prevention and control of hospital infection.

French pre-hospital trauma triage criteria:Does the “prehospital resuscitation” criterion provide additional benefit in triage?

AIM:To evaluate the performance of the specific French Vittel "Pre-Hospital(PH) resuscitation" criteria in selecting polytrauma patients during the pre-hospital stage and its potential to increase the positive predictive value(PPV) of pre-hospital trauma triage.METHODS: This was a monocentric prospective cohort study of injured adults transported by emergency medi-cal service to a trauma center. Patients who met any of the field trauma triage criteria were considered "triage positive". Hospital data was statistically linked to prehospital records. The primary outcome of defining a "major trauma patient" was Injury Severity Score(ISS) > 16. RESULTS: There were a total of 200 injured patients evaluated over a 2 years period who met at least 1 triage criterion. The number of false positives was 64 patients(ISS < 16). The PPV was 68%. The sensitivity and the negative predictive value could not be evaluated in this study since it only included patients with positive Vittel criteria. The criterion of "PH resuscitation" was present for 64 patients(32%),but 10 of them had an ISS < 16. This was statistically significant in correlation with the severity of the trauma in univariate analysis(OR = 7.2; P = 0.005; 95%CI: 1.6-31.6). However,despite this correlation the overall PPV was not significantly increased by the use of the criterion "PH resuscitation"(68% vs 67.8%).CONCLUSION: The criterion of "pre-hospital resuscitation" was statistically significant with the severity of the trauma,but did not increase the PPV. The use of "prehospital resuscitation" criterion could be re-considered if these results are confirmed by larger studies.

Evaluation wiht Computer of the Personnel Needed for Triage and Operation of the Wounded in Nuclear Warfare

When the troops are attacked by nuclear weapons, the number of the wounded and thetype and the condition of the wounds will change with the equivalence and the way of explosion, thenumber of soldiers taking part, the area of the disposition of the troops, and the conditions of protectionof the personnel. Whether the wounded by nuclear weapons who is pouring in enormous amountcan be correctly classified in time has a very important relation in enhancing the effect of the first-aidand the treatment later on. We worked out a programme about the defined types and criteria of thewounded by nuclear weapons beforehand to be stored into the microcomputer. After nuclear cxplo-sion, it is necessary only to input the known data into the microcomputer from the key-board, thecomputer will immediately tell the number of the wounded of various types, the number of peopleand the time needed to perform the triage task and the surgical personnel needed to performthe operations, so that medical supporting programme can be selected or adjusted on time and the ef-ficiency and quality of the triage and first-aid work can be improved.

Criteria for level 1 and level 2 trauma codes: Are pelvic ring injuries undertriaged?

AIM: To determine the association of unstable pelvic ring injuries with trauma code status.METHODS: A retrospective review of all pelvic ring injuries at a single academic center from July 2010 to June 2013 was performed. The trauma registry was used to identify level 1 and level 2 trauma codes for each injury. The computed tomography scans in all patients were classified as stable or unstable using the Abbreviated Injury Scale. Pelvic injury classifications in level 1 and level 2 groups were compared. Patient disposition at discharge in level 1 and level 2 groups were also compared.RESULTS: There were 108 level 1 and 130 level 2 blunt trauma admissions. In the level 1 group, 67% of pelvic injuries were classified as stable fracture patterns and 33% were classified as unstable. In the level 2 group, 62% of pelvic injuries were classified as stable fracture patterns and 38% were classified as unstable. level 1 trauma code was not associated with odds of having an unstable fracture pattern(OR = 0.83, 95%CI: 0.48-1.41, P = 0.485). In the level 1 group with unstable pelvic injuries, 33% were discharged to home, 36% to a rehabilitation facility, and 32% died. In the level 2 group with unstable pelvic injuries, 65% were discharged to home, 31% to a rehabilitation facility, and 4% died. For those with unstable pelvic fractures(n = 85), assignment of a level 2 trauma code was associated with reduced odds of death(OR = 0.07, 95%CI: 0.01-0.35, P = 0.001) as compared to being discharged to home.CONCLUSION: Trauma code level assignment is not correlated with severity of pelvic injury. Because an unstable pelvis can lead to hemodynamic instability, these injuries may be undertriaged.