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Denver ED Trauma Organ Failure Score predicts healthcare resource utilization in adult trauma patients

Published:August 30, 2018DOI:https://doi.org/10.1016/j.ajem.2018.08.073

      Abstract

      Background

      Early identification of trauma patients who need specialized healthcare resources may facilitate goal-directed resuscitation and effective secondary triage.

      Objective

      To estimate associations between Denver Emergency Department (ED) Trauma Organ Failure (TOF) Score and healthcare resource utilization.

      Methods

      Retrospective study of adult trauma patients at Denver Health Medical Center. The outcome was resource utilization including: intensive care unit (ICU) length of stay (LOS), hospital LOS, procedures, and costs. Multivariable regression analyses were used to estimate associations between moderate- or high-risk patients, as determined by the Denver ED TOF Score, and healthcare resource utilization.

      Results

      We included 3000 patients with a median age of 42 (IQR 27–56) years, 71% male, median injury severity score 9 (IQR 5–16), and 83% blunt mechanism. Among the cohort, 1379 patients (46%) were admitted to the ICU and 122 (4%) died. The adjusted relative risk for high- and moderate-risk as compared to low risk for number of procedures performed was 2.31 (95% CI 2.07–2.57) and 1.80 (95% CI 1.59–2.03) respectively; ICU LOS was 2.87 (95% CI 2.70–3.05) and 1.71 (95% CI 1.60–1.83) respectively; hospital LOS was 3.33 (95% CI 3.21–3.45) and 1.97 (95% CI 1.90–2.05) respectively. The adjusted geometric mean for high-, moderate-, and low-risk for costs was $48,881 (95% CI $43,799–$54,552), $27,890 (95% CI $25,460–$30,551), and $12,983 (95% CI $12,493–$13,492), respectively.

      Conclusions

      The Denver ED TOF Score predicts healthcare resource utilization, and is a useful bedside tool to identify patients early after injury that are likely to require significant healthcare resources and specialized trauma care.

      Keywords

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