Health Research and Policy

Research in Progress Seminar (RIP)

Date: May 8, 2013
Time: 1:30 pm - 3:00 pm
Location: Medical School Office Building, Rm x303
Speakers: Kit Kelgado, MD, MS
Surgery, Emergency Medicine
Title: Optimizing the Regionalization of Trauma Care in the U.S. Through More Cost-effective Field Triage and by Reducing Interhospital Transfer Disparities


Trauma is the leading cause of death before the age of 44 and leading cause of potential years of life lost before the age of 65. Receiving care in a specialized trauma center reduces mortality by 25% among patients with severe injuries. Thus states have established emergency medical services (EMS) and trauma systems to ensure that patients with severe injuries are "regionalized" to designated trauma centers. The Centers of Disease Control and Prevention (CDC) has established national guidelines to improve the accuracy of field triage of injured patients to trauma centers. This research in progress seminar will summarize the results of three interrelated projects:

  1. Estimate the annual proportion of patients with severe injuries who are "undertriaged" to non-trauma centers from the field of injury using the 2009 National Emergency Department Sample (NEDS) from the AHRQ Health Care Utilization Project.
  2. Estimate the annual number of lives that could be saved as well as change in health care costs related to full adoption of the CDC Field Triage Guidelines for Injured Patients compared to current triage performance in the U.S. using a cost-effectiveness model. We also use the model to find the maximum improvement in triage sensitivity at which tradeoffs in decreased specificity can still be cost-effective.
  3. Finally, for patients who are "undertriaged" initially to a non-trauma center emergency department (ED), we analyzed the NEDS to identify factors associated with hospitalizing patients at the non-trauma center vs. transferring patients to another facility from the ED for a higher level of care. We hypothesize that after adjusting for patient, injury, and hospital characteristics, that patients who have any type of insurance are more likely to be admitted at the non-trauma center from the ED rather than be transferred to a trauma center. Thus, these patients may be systematically get worse care.
Please note: All research in progress seminars are off-the-record. Any information about methodology/press release and/or results are embargoed until publication.
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