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. 2024 Feb;175(2):522-528.
doi: 10.1016/j.surg.2023.10.024. Epub 2023 Nov 27.

Characterizing re-triage guidelines: A scoping review of states' rules and regulations

Conor T Broderick  1 , John D Slocum  1 , Michael Visenio  1 , David Jelke  1 , Joseph Albanese  2 , Mary Beth Voights  3 , Richard J Fantus  4 , Evert A Eriksson  5 , Sarah Lombardo  6 , Stephanie L Bonne  7 , George C Velmahos  8 , Elinore Kaufman  9 , Robert C Mackersie  10 , Anne M Stey  11
Affiliations

Characterizing re-triage guidelines: A scoping review of states' rules and regulations

Conor T Broderick et al. Surgery. 2024 Feb.

Abstract

Background: State guidelines for re-triage, or emergency inter-facility transfer, have never been characterized across the United States.

Methods: All 50 states' Department of Health and/or Trauma System websites were reviewed for publicly available re-triage guidelines within their rules and regulations. Communication was made via phone or email to state agencies or trauma advisory committees to obtain or confirm the absence of guidelines where public data was unavailable. Guideline criteria were abstracted and grouped into domains of Center for Disease Control Field Triage Criteria: pattern/anatomy of injury, vital signs, special populations, and mechanisms of injury. Re-triage criteria were summarized across states using median and interquartile ranges for continuous data and frequencies for categorical data. Demographic data of states with and without re-triage guidelines were compared using the Wilcoxon rank sum test.

Results: Re-triage guidelines were identified for 22 of 50 states (44%). Common anatomy of injury criteria included head trauma (91% of states with guidelines), spinal cord injury (82%), chest injury (77%), and pelvic injury (73%). Common vital signs criteria included Glasgow Coma Score (91% of states) ranging from 8 to 14, systolic blood pressure (36%) ranging from 90 to 100 mm Hg, and respiratory rate (23%) with all using 10 respirations/minute. Common special populations criteria included mechanical ventilation (73% of states), age (68%) ranging from <2 or >60 years, cardiac disease (59%), and pregnancy (55%). No significant demographic differences were found between states with versus without re-triage guidelines.

Conclusion: A minority of US states have re-triage guidelines. Characterizing existing criteria can inform future guideline development.

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Conflict of interest statement

COI/DISCLOSURES

Evert A. Eriksson: DePuy Synthes speaker for rib fractures and repair

Figures

Figure 1:
Figure 1:
Screening Flowchart of Scoping Review of States’ Trauma and Emergency Medical Services Rules and Regulations to Identify Re-Triage Guidelines
Figure 2:
Figure 2:
States With and Without Re-Triage Guidelines
See this image and copyright information in PMC

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