{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,7]],"date-time":"2026-08-07T16:05:30Z","timestamp":1786118730241,"version":"build-2736575974"},"reference-count":19,"publisher":"SAGE Publications","license":[{"start":{"date-parts":[[2026,8,3]],"date-time":"2026-08-03T00:00:00Z","timestamp":1785715200000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["The American Surgeon\u2122"],"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Emergency department (ED) length of stay (LOS) is commonly used as a trauma-system performance measure, but in trauma it may reflect triage priority and disposition workflow rather than clinical risk. We evaluated whether trauma activation was associated with ED LOS and whether ED LOS independently predicted adverse outcomes.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We performed a retrospective cohort study of adult trauma encounters at an ACS-verified Level I trauma center from January 2018 through January 2020. Higher activation (partial\/full) was compared with lower activation (consult\/no activation). Outcomes were ED LOS, a nonmortality performance-improvement (PI)-listed adverse-event composite, in-hospital mortality, and 30-day readmission. Multivariable logistic regression adjusted for age, sex, Injury Severity Score, transfer status, activation group, and mechanism.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Among 5055 encounters, 2889 (57.2%) had higher activation and 2166 (42.8%) lower activation. Median ED LOS was shorter with higher activation (148 vs 323 minutes;\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      &lt; 0.001). Unadjusted mortality (5.8% vs 1.6%;\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      &lt; 0.001) and adverse events (10.1% vs 4.5%;\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      &lt; 0.001) were higher, while readmission was similar (2.7% vs 2.2%;\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      = 0.301). Adjusted ED LOS was not associated with the nonmortality PI composite (OR\/h, 1.00; 95% CI, 0.95-1.06;\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      = 0.908) but was inversely associated with mortality (OR\/h, 0.82; 95% CI, 0.72-0.94;\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      = 0.005); this association did not persist after excluding deaths before inpatient admission.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Higher activation was associated with shorter ED LOS despite greater injury severity. ED LOS was not independently associated with the nonmortality PI-listed adverse-event composite and should be interpreted as a marker of triage priority, workflow, and disposition rather than as an isolated outcome endpoint.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1177\/00031348261474175","type":"journal-article","created":{"date-parts":[[2026,8,4]],"date-time":"2026-08-04T00:28:54Z","timestamp":1785803334000},"update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":0,"title":["Emergency Department Length of Stay in Trauma: A Marker of Triage Priority and Workflow Rather Than Outcome Risk"],"prefix":"10.1177","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-3988-7193","authenticated-orcid":false,"given":"Vladislav","family":"Muldiiarov","sequence":"first","affiliation":[{"name":"University of Nebraska Medical Center"},{"name":"St. Joseph\u2019s Hospital and Medical Center"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ashley","family":"Campbell","sequence":"additional","affiliation":[{"name":"University of Nebraska Medical Center"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0007-8929-7531","authenticated-orcid":false,"given":"Emma","family":"Stenner","sequence":"additional","affiliation":[{"name":"University of Nebraska Medical Center"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jacob","family":"Herbek","sequence":"additional","affiliation":[{"name":"University of Nebraska Medical Center"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ben","family":"Ravnsborg","sequence":"additional","affiliation":[{"name":"University of Nebraska Medical Center"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"John","family":"Tierney","sequence":"additional","affiliation":[{"name":"University of Nebraska Medical Center"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9190-1880","authenticated-orcid":false,"given":"W. T. Hillman","family":"Terzian","sequence":"additional","affiliation":[{"name":"University of Nebraska Medical Center"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mike","family":"Matos","sequence":"additional","affiliation":[{"name":"University of Nebraska Medical Center"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Emily","family":"Cantrell","sequence":"additional","affiliation":[{"name":"University of Nebraska Medical Center"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9409-2193","authenticated-orcid":false,"given":"Zachary M.","family":"Bauman","sequence":"additional","affiliation":[{"name":"University of Nebraska Medical Center"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"179","published-online":{"date-parts":[[2026,8,3]]},"reference":[{"key":"e_1_3_5_2_2","doi-asserted-by":"publisher","DOI":"10.1067\/mem.2003.302"},{"key":"e_1_3_5_3_2","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0203316"},{"key":"e_1_3_5_4_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.annemergmed.2018.10.007"},{"key":"e_1_3_5_5_2","doi-asserted-by":"publisher","DOI":"10.1111\/j.1553-2712.2011.01236.x"},{"key":"e_1_3_5_6_2","doi-asserted-by":"publisher","DOI":"10.1097\/01.CCM.0000266585.74905.5A"},{"key":"e_1_3_5_7_2","doi-asserted-by":"publisher","DOI":"10.1097\/TA.0b013e3182175199"},{"key":"e_1_3_5_8_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jss.2024.10.024"},{"key":"e_1_3_5_9_2","doi-asserted-by":"publisher","DOI":"10.26635\/6965.5770"},{"key":"e_1_3_5_10_2","doi-asserted-by":"publisher","DOI":"10.1503\/cjs.000218"},{"key":"e_1_3_5_11_2","doi-asserted-by":"publisher","DOI":"10.1186\/1749-7922-8-48"},{"key":"e_1_3_5_12_2","doi-asserted-by":"publisher","DOI":"10.1007\/s00068-024-02644-2"},{"key":"e_1_3_5_13_2","doi-asserted-by":"publisher","DOI":"10.5847\/wjem.j.1920-8642.2023.016"},{"key":"e_1_3_5_14_2","doi-asserted-by":"publisher","DOI":"10.1177\/0885066621995426"},{"key":"e_1_3_5_15_2","doi-asserted-by":"publisher","DOI":"10.3390\/jcm12010032"},{"key":"e_1_3_5_16_2","doi-asserted-by":"publisher","DOI":"10.1097\/TA.0b013e31805d8f6b"},{"key":"e_1_3_5_17_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.injury.2024.112079"},{"key":"e_1_3_5_18_2","doi-asserted-by":"publisher","DOI":"10.1136\/tsaco-2023-001280"},{"key":"e_1_3_5_19_2","doi-asserted-by":"publisher","DOI":"10.3390\/jcm13061714"},{"key":"e_1_3_5_20_2","doi-asserted-by":"publisher","DOI":"10.1136\/tsaco-2024-001479"}],"container-title":["The American Surgeon\u2122"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/journals.sagepub.com\/doi\/pdf\/10.1177\/00031348261474175","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.sagepub.com\/doi\/full-xml\/10.1177\/00031348261474175","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.sagepub.com\/doi\/pdf\/10.1177\/00031348261474175","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,8,6]],"date-time":"2026-08-06T16:49:58Z","timestamp":1786034998000},"score":1,"resource":{"primary":{"URL":"https:\/\/journals.sagepub.com\/doi\/10.1177\/00031348261474175"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,8,3]]},"references-count":19,"alternative-id":["10.1177\/00031348261474175"],"URL":"https:\/\/doi.org\/10.1177\/00031348261474175","relation":{},"ISSN":["0003-1348","1555-9823"],"issn-type":[{"value":"0003-1348","type":"print"},{"value":"1555-9823","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,8,3]]},"article-number":"00031348261474175"}}