Profile and Triage Appropriateness of Trauma Patients Triaged Green: A Prospective Cohort Study from a Secondary Care Hospital in India

Abstract Introduction: Triage is an important component of in-hospital trauma care for adequate patient management and to avoid overcrowding in emergency departments (ED). Prioritising the evaluation of non-urgent patients may result in the diversion of workforce from patients requiring immediate care. However, not evaluating these patients may result in missed injuries and poor outcomes. We aimed to evaluate the profile of these non-urgent patients triaged ‘green’, as part of a triage-trial in a secondary-care hospital in India and validate this against the Cape Triage Score (CTS).Methods: We analysed data of patients triaged green in a prospective single-centre cohort study between July 2016 to November 2019. Clinicians at this triage-naive ED were introduced to a triage trial who then assigned a triage category to trauma patients, aged 18 years and above, on initial evaluation. Telephonic follow-up was performed for all patients included in the study. Triage appropriateness was retrospectively analysed using the CTS. Results: We included 4135 trauma patients triaged green. The mean age of patients was 32.8 (±13.1) years, 77% males. The median (IQR) length of stay of admitted patients was 3 (13) days. Half the patients had a mild Injury Severity Score (3-8), with the majority of injuries being blunt (98%). Of the patients triaged green, 97% came in as direct arrivals and 94.4% were discharged from the ED after initial evaluation. As per CTS, nearly three-quarters (74%) of patients were undertriaged ‘green’ by the clinicians in a triage-naive ED. Conclusion: ​​ Three-fourths (74%) of the patients triaged green by clinicians in a secondary care hospital in Mumbai were mistriaged when retrospectively analysed using CTS. This highlights the need for implementation and evaluation of trauma triage training for the in-hospital first responders (clinicians, nurses and other paramedical staff) in the EDs.