Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2022 Feb 1;234(2):139-154.
doi: 10.1097/XCS.0000000000000025.

Field Trauma Triage among Older Adults: A Cost-Effectiveness Analysis

Brandon C Maughan  1 , Amber Lin  1 , Aaron B Caughey  2 , Eileen M Bulger  3 , K John McConnell  4 , Susan Malveau  1 , Denise Griffiths  1 , Craig D Newgard  1
Affiliations

Field Trauma Triage among Older Adults: A Cost-Effectiveness Analysis

Brandon C Maughan et al. J Am Coll Surg. .

Abstract

Background: National guidelines for prehospital trauma triage aim to identify seriously injured patients who may benefit from transport to trauma centers. These guidelines have poor sensitivity for serious injury among older adults. We evaluated the cost-effectiveness of a high-sensitivity triage strategy for older adults.

Study design: We developed a Markov chain Monte Carlo microsimulation model to estimate the cost-effectiveness of high-sensitivity field triage criteria among older adults compared with current practice. The model used a retrospective cohort of 3621 community-dwelling Medicare beneficiaries who were transported by emergency medical services after an acute injury in 7 counties in the northwestern US during January to December 2011. These data informed model estimates of emergency medical services triage assessment, hospital transport patterns, and outcomes from index hospitalization up to 1 year after discharge. Outcomes beyond 1 year were modeled using published literature. Differences in cost and quality-adjusted life years (QALYs) were calculated for both strategies using a lifetime analytical horizon. We calculated the incremental cost-effectiveness ratio (cost per QALY gained) to assess cost-effectiveness, which we defined using a threshold of less than $100,000 per QALY.

Results: High-sensitivity trauma field triage for older adults would produce a small incremental benefit in average trauma system effectiveness (0.0003 QALY) per patient at a cost of $1,236,295 per QALY. Sensitivity analysis indicates that the cost of initial hospitalization and emergency medical services adherence to triage status (ie transporting triage-positive patients to a trauma center) had the largest influence on overall cost-effectiveness.

Conclusions: High-sensitivity trauma field triage is not cost-effective among older adults.

PubMed Disclaimer

References

    1. MacKenzie EJ, Rivara FP, Jurkovich GJ, et al. A national evaluation of the effect of trauma-center care on mortality. N Engl J Med. 2006;354:366–378.
    1. Garwe T, Cowan LD, Neas B, et al. Survival benefit of transfer to tertiary trauma centers for major trauma patients initially presenting to nontertiary trauma centers. Acad Emerg Med. 2010;17:1223–1232.
    1. Garwe T, Stewart KE, Newgard CD, et al. Survival benefit of treatment at or transfer to a tertiary trauma center among injured older adults. Prehosp Emerg Care. 2020;24:245–256.
    1. Newgard CD, McConnell KJ, Hedges JR, et al. The benefit of higher level of care transfer of injured patients from nontertiary hospital emergency departments. J Trauma. 2007;63:965–971.
    1. MacKenzie EJ, Weir S, Rivara FP, et al. The value of trauma center care. J Trauma. 2010;69:1–10.

Publication types

LinkOut - more resources