In the Journal of the American College of Surgeons, M. Kit Delgado and colleagues evaluate the cost-effectiveness of field trauma triage practices (the criteria used to decide whether to transport an injured patient to a major trauma center). The authors compare current triage practices with alternatives that meet national policy benchmarks set by the American College of Surgeons Committee on Trauma (a high-sensitivity field triage strategy that would miss no more than 5% of seriously injured patients) and a moderate sensitivity, high-specificity approach (in which at least 65% of patients sent to trauma centers have injuries serious enough to be there). The authors conducted a cost-effectiveness analysis using 2006-2008 data from nearly 80,000 injured adults transported by 48 emergency medical services agencies to 105 trauma and non-trauma hospitals in the western United States. Incremental differences in one-year and lifetime survival, quality-adjusted life years (QALYs), costs, and the cost-effectiveness ratio (costs per QALY gained) were estimated for each triage strategy using a decision analytic model.
The authors considered an incremental cost-effectiveness ratio threshold of <$100,000 to be cost-effective. For the six regions analyzed, a high-sensitivity triage strategy, which would be consistent with the national targets, would cost $1,317,333 per QALY gained. The authors conclude that a high-sensitivity approach to field triage consistent with national policy is not cost-effective. Current triage practices in the 6 regions were the most cost-effective strategy at the $100,000/QALY gained threshold. The cost-effectiveness of field triage appears closely tied to specificity and overtriage. Guideline-driven emergency transport patterns after triage assessment would reduce mortality and costs, thereby enhancing the cost-effectiveness of field triage, as would attention to the distribution and role of different hospitals in trauma systems.