Table 1.
Triage Cost Effectiveness Input Parameters: Probabilities, Utilities and Cost Items
| Description | Value (95% CI) | Source | |
|---|---|---|---|
| Probability, % | |||
| Severely injured (ISS≥16) | 6.43 (6.26-6.60) | Cohort data | |
| Algorithm sensitivity (100%,% under triage) | |||
| Current triage | 87.2 (86.3-88.1) | Cohort data | |
| High specificity | 71.2 (70.0-72.5) | Cohort data | |
| High sensitivity | 98.6 (98.3-98.9) | Cohort data | |
| Algorithm specificity (100%, % over triage) | |||
| Current triage | 64.0 (63.7-64.4) | Cohort data | |
| High specificity | 66.5 (66.2-66.9) | Cohort data | |
| High sensitivity | 17.1 (16.9-17.4) | Cohort data | |
| Triage adherence (site transported to) | |||
| If ISS≥16, triage positive | |||
| Level I or II TC | 89.3 (88.4-90.2) | Cohort data | |
| Non TC | 10.7 (9.8-11.6) | Cohort data | |
| If ISS≥16, triage negative | |||
| Level I or II TC | 48.4 (44.6-52.2) | Cohort data | |
| Non TC | 51.6 (47.8-55.4) | Cohort data | |
| If ISS<16, triage positive | |||
| Level I or II TC | 80.2 (79.8-80.7) | Cohort data | |
| Non TC | 19.8 (19.3-20.2) | Cohort data | |
| If ISS<16, triage negative | |||
| Level I or II TC | 34.6 (34.2-35.0) | Cohort data | |
| Non TC | 65.2 (65.0-65.8) | Cohort data | |
| Level 1 among transported to TC | |||
| If ISS≥16, triage positive | 91.7 (90.8-92.5) | Cohort data | |
| If ISS≥16, triage negative | 91.8 (88.3-94.4) | Cohort data | |
| If ISS<16, triage positive | 81.8 (81.3-82.3) | Cohort data | |
| If ISS<16, triage negative | 69.2 (68.5-69.9) | Cohort data | |
| Transfer from non TC to TC | |||
| If ISS≥16 | |||
| If triage positive | 26.5 (22.8-30.6) | Cohort data | |
| If triage negative | 32.5 (27.7-37.6) | Cohort data | |
| If ISS<16 | |||
| If triage positive | 7.4 (6.7-8.1) | Cohort data | |
| If triage negative | 4.3 (4.1-4.6) | Cohort data | |
| In-hospital mortality | |||
| if ISS≥16 | |||
| Treated in level I TC | 10.0 (9.2-10.9) | Cohort data | |
| RR if treated in level II TC15* | 1.00 | Reference 15 | |
| RR if treated in non-TC15 | 1.25 (1.00-1.58) | Reference 14 | |
| If ISS<16 | 1.2 (1.2-1.3) | Cohort data | |
| 1-y Mortality after initial discharge | |||
| If ISS≥16 | |||
| Treated in TC 15 | 3.0 (2.5-3.5) | Reference 15 | |
| RR if treated in non-TC15† | 1.64 (1.08-2.49) | Reference 15 (calculated†) | |
| If ISS<16 51 | 1.7 (1.6-1.8) | Reference 51 | |
| Baseline lifetime mortality after 1-y 36 | age-specific | Reference 36 | |
| Hazard ratios for lifetime mortality 37 | |||
| If ISS≥16 | 5.19 (3.94-6.52) | Reference 37 | |
| If ISS<16 | 1.38 (1.09-1.69) | Reference 37 | |
| Utility | |||
| 1-y quality of life | |||
| If ISS≥16 | |||
| Treated in TC 21 | 0.70 (0.60-0.79) | Reference 21 | |
| Treated in non-TC 21 | 0.68 (0.57-0.78) | Reference 21 | |
| If ISS<1634 | 0.80 (0.66-0.93) | Reference 21 | |
| Yearly decrease in quality of life, % 25 | 3.0 | Reference 25 | |
| Mean adjusted per-patient cost‡ | |||
| Initial treatment14 | |||
| If ISS≥16 | |||
| Level 1 TC | 33,525 (32,724-34,326) | Cohort data, Reference 14 | |
| Level 2 TC | 26,481 (25,161-27,801) | Cohort data, Reference 14 | |
| Non TC, no transfer | 19,889 (18,894-20,884) | Cohort data, Reference 14 | |
| Non TC, transfer | 22,578 (20,908-24,247) | Cohort data, Reference 14 | |
| If ISS<16 | |||
| Level 1 TC | 24,903 (24,370-25,436) | Cohort data, Reference 14 | |
| Level 2 TC | 19,835 (19,453-20,217) | Reference 14 Cohort data, | |
| Non TC, no transfer | 14,255 (13,928-14,582) | Cohort data, Reference 14 | |
| Non TC, transfer | 16,178 (15,685-16,672) | Cohort data, Reference 14 | |
| 1-y Post-injury treatment after discharge | |||
| If ISS≥16 21 | |||
| TC (level 1 and 2, including transfer) | 35,081 (31,509-38,653) | Reference 21 | |
| Non TC | 34,442 (31,230-37,654) | Reference 21 | |
| If ISS<1635,52 | |||
| TC (level 1 and 2, including transfer) | 9,300 (8,300-10,200) | References35,52 | |
| Non TC | 10,400 (9,600-11,300) | References35,52 | |
| % Increase in lifetime healthcare expenditure 42 | |||
| If ISS≥16 | 1.45 (1.10-1.81) | Reference 42 | |
| If ISS<16 | 1.25 (1.02-1.57) | Reference 42 | |
| Yearly decrease in cost, %25 | 3.0 | Reference 25 | |
Level II trauma centers are assumed to have the same mortality reduction as Level I trauma centers. The scenario of lower mortality reduction for Level II trauma centers is tested in a sensitivity analysis.
Relative risk of 1-year mortality for seriously injured (ISS ≥ 16) patients discharged alive from non-trauma centers is calculated based on 20% in-hospital mortality reduction and 25% one-year mortality reduction in major trauma centers, compared to non-trauma centers. Approximate relative risk = ((trauma center in-hospital mortality + trauma center one-year mortality after discharge alive)/(100% - trauma center one-year mortality reduction) − trauma center in-hospital mortality/ (100% - trauma center inhospital mortality)) / trauma center one-year mortality after discharged alive = ((10%+3%)/(100%-25%)-10%/(100%-20%))/3%=1.64. Inaccuracy is due to rounding.
Adjusted to 2008 dollars
RR, relative risk; TC, trauma center; ISS, Injury Severity Score.