{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,2,21]],"date-time":"2025-02-21T03:07:58Z","timestamp":1740107278014,"version":"3.37.3"},"reference-count":10,"publisher":"Wiley","issue":"5","license":[{"start":{"date-parts":[[2017,12,6]],"date-time":"2017-12-06T00:00:00Z","timestamp":1512518400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"},{"start":{"date-parts":[[2017,12,6]],"date-time":"2017-12-06T00:00:00Z","timestamp":1512518400000},"content-version":"unspecified","delay-in-days":0,"URL":"http:\/\/www.springer.com\/tdm"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["World j. surg."],"published-print":{"date-parts":[[2018,5]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Background<\/jats:title><jats:p>Under\u2010triaged trauma patients have worse clinical outcomes. We evaluated the capability of four pre\u2010hospital variables to identify this population at the lowest level trauma activation (level 3).<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>A retrospective review of adult trauma activations from 2004 to 2014 was completed. Pre\u2010hospital vital signs and Glasgow Coma Scale were converted to categorical variables. Patients were under\u2010triaged based on meeting current level 1 or 2 criteria, or requiring a pre\u2010defined critical intervention. Logistic regression was used to determine the association between the pre\u2010hospital variables and under\u2010triaged patients. Odds ratios and 95% confidence intervals were calculated for a comprehensive model, grouping all causes of under\u2010triage as a single unit, and 16\u00a0individual models, one for each under\u2010triage criterion. A new level 2 criterion was generated and internally validated.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>In total, 12,332 activations occurred during the study period. Four hundred and sixty\u2010six (5.9%) patients were under\u2010triaged. Compared to patients with a normal respiratory rate (RR), tachypneic patients were more likely to be under\u2010triaged for any reason, OR 1.7 [1.3\u20132.1], <jats:italic>p<\/jats:italic> &lt; 0.001. In the individual event analysis, tachypneic patients were more likely to have flail chest, OR 22 [2.9\u2013168.3], <jats:italic>p<\/jats:italic> = 0.003; require a chest tube, OR 3 [1.8\u20134.9], <jats:italic>p<\/jats:italic> &lt; 0.001; or require emergent intubation, OR 1.6 [1.1\u20132.8], <jats:italic>p<\/jats:italic> = 0.04, compared to patients with a normal RR. The data\u2010driven triage modification was tachypnea with suspected thoracic injury which reduced the under\u2010triage rate by 1.2%.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>Tachypnea with suspected thoracic injury is the strongest level 2 triage modification to reduce level 3 under\u2010triage.<\/jats:p><\/jats:sec>","DOI":"10.1007\/s00268-017-4353-4","type":"journal-article","created":{"date-parts":[[2017,12,6]],"date-time":"2017-12-06T16:26:11Z","timestamp":1512577571000},"page":"1321-1326","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":11,"title":["The Respiratory Rate: A Neglected Triage Tool for Pre\u2010hospital Identification of Trauma Patients"],"prefix":"10.1002","volume":"42","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-1968-7116","authenticated-orcid":false,"given":"John D.","family":"Yonge","sequence":"first","affiliation":[{"name":"Division of Trauma, Critical Care, and Acute Care Surgery, Department of Surgery Oregon Health and Science University 3181 SW Sam Jackson Park Road, Mail Code: L611 97239 Portland OR USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Phillip Kemp","family":"Bohan","sequence":"additional","affiliation":[{"name":"Division of Trauma, Critical Care, and Acute Care Surgery, Department of Surgery Oregon Health and Science University 3181 SW Sam Jackson Park Road, Mail Code: L611 97239 Portland OR USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Justin J.","family":"Watson","sequence":"additional","affiliation":[{"name":"Division of Trauma, Critical Care, and Acute Care Surgery, Department of Surgery Oregon Health and Science University 3181 SW Sam Jackson Park Road, Mail Code: L611 97239 Portland OR USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Christopher R.","family":"Connelly","sequence":"additional","affiliation":[{"name":"Division of Trauma, Critical Care, and Acute Care Surgery, Department of Surgery Oregon Health and Science University 3181 SW Sam Jackson Park Road, Mail Code: L611 97239 Portland OR USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Lynn","family":"Eastes","sequence":"additional","affiliation":[{"name":"Division of Trauma, Critical Care, and Acute Care Surgery, Department of Surgery Oregon Health and Science University 3181 SW Sam Jackson Park Road, Mail Code: L611 97239 Portland OR USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Martin A.","family":"Schreiber","sequence":"additional","affiliation":[{"name":"Division of Trauma, Critical Care, and Acute Care Surgery, Department of Surgery Oregon Health and Science University 3181 SW Sam Jackson Park Road, Mail Code: L611 97239 Portland OR USA"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2017,12,6]]},"reference":[{"issue":"1","key":"e_1_2_7_2_2","first-page":"1","article-title":"Guidelines for field triage of injured patients: recommendations of the National Expert Panel on Field Triage, 2011","volume":"61","author":"Sasser SM","year":"2012","journal-title":"MMWR Recomm Rep"},{"key":"e_1_2_7_3_2","first-page":"1","article-title":"Resources for optimal care of the injured patient","volume":"1","author":"Rotondo MM","year":"2014","journal-title":"Comm Trauma Am Coll 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