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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Article Info
Publication History
Published online: August 30, 2018
Accepted:
August 27,
2018
Received in revised form:
August 23,
2018
Received:
February 12,
2018
Footnotes
☆Supported, in part, by the National Institute of General Medical Sciences (Dr. Vogel [ F32 GM099344 ]), the Agency for Healthcare Research and Quality (Dr. Vogel [ K08 HS023901 ]), and National Institute of Allergy and Infectious Diseases (Dr. Haukoos [ R01 AI106057 ]).
Identification
Copyright
© 2018 Elsevier Inc. All rights reserved.
