• Jody A Vogel, W Gannon Sungar, Dowin Boatright, Jordan Ryan, Benjamin Murphy, Jesse Loar, Sabrina Adams, and Jason S Haukoos.
• Department of Emergency Medicine, Denver Health Medical Center, Denver, CO, USA; Department of Emergency Medicine, University of Colorado School of Medicine, Aurora, CO, USA. Electronic address: jody.vogel@ucdenver.edu.
• Am J Emerg Med. 2019 Jun 1; 37 (6): 1108-1113.

BackgroundEarly identification of trauma patients who need specialized healthcare resources may facilitate goal-directed resuscitation and effective secondary triage.ObjectiveTo estimate associations between Denver Emergency Department (ED) Trauma Organ Failure (TOF) Score and healthcare resource utilization.MethodsRetrospective study of adult trauma patients at Denver Health Medical Center. The outcome was resource utilization including: intensive care unit (ICU) length of stay (LOS), hospital LOS, procedures, and costs. Multivariable regression analyses were used to estimate associations between moderate- or high-risk patients, as determined by the Denver ED TOF Score, and healthcare resource utilization.ResultsWe included 3000 patients with a median age of 42 (IQR 27-56) years, 71% male, median injury severity score 9 (IQR 5-16), and 83% blunt mechanism. Among the cohort, 1379 patients (46%) were admitted to the ICU and 122 (4%) died. The adjusted relative risk for high- and moderate-risk as compared to low risk for number of procedures performed was 2.31 (95% CI 2.07-2.57) and 1.80 (95% CI 1.59-2.03) respectively; ICU LOS was 2.87 (95% CI 2.70-3.05) and 1.71 (95% CI 1.60-1.83) respectively; hospital LOS was 3.33 (95% CI 3.21-3.45) and 1.97 (95% CI 1.90-2.05) respectively. The adjusted geometric mean for high-, moderate-, and low-risk for costs was $48,881 (95% CI $43,799-$54,552), $27,890 (95% CI $25,460-$30,551), and $12,983 (95% CI $12,493-$13,492), respectively.ConclusionsThe Denver ED TOF Score predicts healthcare resource utilization, and is a useful bedside tool to identify patients early after injury that are likely to require significant healthcare resources and specialized trauma care.Copyright © 2018 Elsevier Inc. All rights reserved.

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