ASSOCIATION FOR ACADEMIC SURGERY AND SOCIETY OF UNIVERSITY SURGEONS—ABSTRACTS 271

platelets stored for 3 or more days. Because platelet transfusions al-most universally occur between the 3rd and 5th day of storage, ourfindings suggest that stored platelets may have deceased mitochon-drial function and impaired clotting capabilities. Further in vivo anal-ysis is clearly warranted.

TRAUMA/CRITICAL CARE 2: TRANSLATIONALRESEARCH FOCUSED ON FIRST FEW

MOMENTS AFTER INJURY

33.1. Does Scene Physiology Predict Helicopter TransportTrauma Admission. A. J. Medvecz,1 J. B. Hill,3 J.Brywczynski,1,2 O. Gunter,1,2 M. Davidson,2 O.Guillamondegui1,2; 1Vanderbilt University School of Medicine,Nashville, Tennessee; 2Vanderbilt University Medical Center,Nashville, Tennessee; 3NYU Langone Medical Center, NewYork, New York

Introduction: Helicopter transport (HT) is necessary in the manage-ment of civilian trauma, but its significant expense underscores theneed to minimize overuse and inefficiency. In order to determine ifHT is required for trauma patients, accurate patient evaluationandappropriate triage at the injury scene by the pre-hospital responseteam is essential. The objective of this study is to determine if on-scene physiologic criteria predict appropriate triage in trauma pa-tients transported by helicopter to a Level I trauma center.Methods:We performed a retrospective review of adult patients flownfrom the injury scene to the emergency department (ED) of a Level 1trauma center by a university air transport service from January2006 to December 2010. Demographics, mechanism of injury, fieldphysiologic data (scene revised trauma score, RTS), distance fromscene, trauma alert level, payor status, ED and hospital dispositionand injury severity scores (ISS) were queried from the electronicmed-ical record and Trauma Registry of the American College of Surgeons(TRACS). Comparison data was collected on trauma patients admit-ted by ground transport. Proper triage criteria were defined throughthe American College of Surgeons Committee on Trauma: ICU admis-sion, hospital stay >48 hrs, ED disposition to the operating room, ordeath. Chi-squared, Wilcoxon rank-sum test and logistic regressionto identify predictors for proper- versus over-triage. Results:We iden-tified 2522 HT patients. of these, 1491(59%) were properly-triagedand 1031(41%) were over-triaged. Univariate analysis revealedmean scene RTS was significantly higher for over- versus proper-tri-age (7.686 0.67 and 6.976 1.57 respectively, P<.001). Neither sceneRTS nor travel distance predicted triage criteria in a regressionmodel(odds ratio [OR] 0.37, 95% confidence interval [CI] 0.16-0.85, and OR0.67, 95% CI 0.60-0.74, respectively). Compared to ground transport,

admitted HT patients significantly suffered more blunt trauma (89%v. 77%), lower sceneRTS (7.16 1.5 v. 7.46 1.0), higher ISS (206 12 v.156 10), more ICU days (2.16 5.5 v. 1.56 4.1), more ventilator days(2.1 6 5.8 v. 1.1 6 3.6), greater length of stay (7.1 6 9.5 v. 5.7 6 7.2),greater travel distance (40.9 6 17.6 v. 12.6 6 14.9 miles), and weremore likely to be intubated (34% v. 15%). Conclusions: Physiologic cri-teria did not predict triage status in HT trauma patients. Although>40% of HT patients were over-triaged, they were more severely in-jured and required greater institutional resources than ground trans-port patients. These data support that despite limitations in definingtriage status by scene physiologic criteria, over-triage from a helicop-ter transport program is appropriate.

33.2. Withdrawn

33.3. Utilization of the Random Forest Algorithm to PredictTrauma Patient Disposition Based on Pre-hospital Vari-ables. M. L. Scerbo, H. Radhakrishnan, B. Cotton, A. Dua, D.DelJunco, C. Wade, J. B. Holcomb; Center For TranslationalInjury Research (CeTIR), Department of Surgery, Universityof Texas Health Science Center At Houston, Houston, Texas

Introduction: Effective triage of trauma patients is critical for efficientutilization of trauma system resources. While under-triage can havedevastating consequences, over-triage not onlywastes resources but dis-places the patient from their community and causes delay of treatmentfor themore seriously injured. Anaccepted over-triage rate of 50%estab-lished in 1999 has been re-evaluated but never successfully reduced. Ef-ficient resource management requires emergency medical services(EMS) personnel to correctly triage patients to the appropriate traumacenter. This retrospective study aimed to validate the Random Forestcomputer model using pre-hospital variables as means of triagingtrauma patients. Methods: Adult trauma patients classified as ‘tier 2’presenting via helicopter to a Level I Trauma Center with a 3-tiered tri-age system from May 2007 to May 2008 were included. Transfer andburn patientwere excluded. Patientmedical chartswere reviewed retro-spectively. Variables included demographics, mechanism of injury, pre-hospital fluid, medications, vitals, and disposition. Statistical analysiswas performed via the RandomForest Algorithm that analyzed pre-hos-pital variables to predict patient disposition. The patient disposition pre-diction from the computermodel was compared against the documenteddisposition in order to determine the accuracy of this algorithm. Results:A total of 1,653 patientswere included in this study. The RandomForestmodel predicted patient disposition with a sensitivity of 89%, specificityof 42%, negative predictive value of 92% and positive predictive value of34%. From our patient group, 28% required level I care while 72% couldhave been managed in a level III facility yet were transported via heli-copter to a level I. Using our computer model this rate could have beenreduced by 31%with an under-triage rate of 2.8%. Conclusions: Pre-hos-pital data can be used to appropriately triage trauma patients using theRandom Forest model. While prospective validation is required, it ap-pears that complex computer modeling can be used to guide triage deci-sions allowing both more accurate triage and more efficient use of thetrauma system, without negatively affecting patient outcomes.

33.4. Bedside Sonographic Assessment of Intravascular Vol-ume Status in the Surgical Intensive Care Unit: Is Sub-clavian Vein Collapsibility Equivalent to Inferior VenaCava Collapsibility? A. J. Kent, D. P. Bahner, D. S.Eiferman, C. T. Boulger, A. Springer, E. J. Adkins, D. C.Evans, S. Yeager, G. J. Roelant, S. P. Stawicki; The OhioState University College of Medicine, Columbus, OH

Introduction: Hemodynamic assessment utilizing intensivist-performedbedside sonography is an actively evolving clinical area. Inferior venacava collapsibility index (IVC-CI) has been shown to correlate with both