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ICU triage in terror-related mass casualty events

Introduction

Admitting patients to the ICU is one of the triage processes needed during mass casualty events (MCE). The high occupancy of the ICU and the fact that it cannot be readily evacuated make this process even more challenging [1, 2]. We compared the triage to the ICU in terror-related MCE versus other trauma in Israel.

Methods

A retrospective cohort study of all patients recorded in the Israeli National Trauma registry (ITR) that were injured in MCE secondary to terrorist acts by explosions from 1 October 2000 to 31 December 2005. Medical records of all patients hospitalized in the ICU were retrieved and reviewed. Over-triage was defined as a patient that is discharged from the ICU within 24 hours of admission without any specific intervention besides monitoring. Under-triage was defined as an admission to the ICU more than 24 hours after an admission to a different department.

Results

The ITR included 122,208 patients during the study period. A total of 1,272 patients (1.0%) were injured in terror-related MCE. Three hundred and sixty-five patients (28.7%) of the MCE group and 9,093 patients (7.5%) of the non-MCE group were admitted to the ICU. Eighty-one (6.4%) of the patients in the MCE group and 2,445 (2.0%) of the patients in the non-MCE group were admitted to the ICU and discharged within 24 hours (P < 0.0001). A total of 3.3% of the patients in the MCE and 9.2% of the patients in the non-MCE group were admitted to the ICU more than 24 hours after admission to another department. Patients that were over-triaged to the ICU during MCE had significantly more injuries, and to more body regions, than the patients that were over-triaged to the ICU due to non-MCE trauma.

Conclusion

Over-triage to the ICU is probably unavoidable in MCE. This fact and the increased injury severity, anticipated in terror-related MCE, should lead the hospital to adopt a plan for expansion of the ICU capabilities. A post-event ICU re-evaluation round and judicious patient discharge may reduce prolonged overuse of ICU resources.

References

  1. 1.

    Frykberg ER: Medical management of disasters and mass casualties from terrorist bombings: how can we cope? J Trauma 2002, 53: 201-212. 10.1097/00005373-200208000-00001

  2. 2.

    Sprung CL, et al.: Evaluation of triage decisions for intensive care admission. Crit Care Med 1999, 27: 1073-1079. 10.1097/00003246-199906000-00021

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Klein, Y., Klein, M. & Peleg, K. ICU triage in terror-related mass casualty events. Crit Care 13, P464 (2009). https://doi.org/10.1186/cc7628

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Keywords

  • Cohort Study
  • Medical Record
  • Emergency Medicine
  • Specific Intervention
  • Retrospective Cohort