A simplified trauma triage system safely reduces overtriage and improves provider satisfaction: a prospective study
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Updated: Apr 16, 2026

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Published on: January 15, 2017
Robert R Shawhan1, Derek P McVay1, Linda Casey1
1Department of Surgery, Madigan Army Medical Center, 9040-A Fitzsimmons Drive, Tacoma, WA 98431, USA.
Background:
Standard triage systems result in high rates of overtriage to achieve acceptably low undertriage. We previously validated optimal triage variables and used these to implement a new simplified triage system (NEW) at our hospital.
Methods:
All trauma entries from May 2010 to Feb 2013 were prospectively reviewed. Calculation of the undertriage and overtriage rates was based on the need for any urgent or life-saving intervention.
Results:
We identified 704 trauma patients. Level 1 activations were reduced from 32% (OLD) to 19% in the NEW system (P < .05). Overtriage was reduced from 79% (OLD) to 44% in the NEW system (P < .01). The undertriage rate was 1.6% in the NEW system, compared with 1.2% in the OLD system (P = nonsignificant). Of all patients, 14% (63) required a life-saving intervention. There were no deaths among undertriaged patients.
Conclusion:
The NEW simplified triage system significantly reduced the rate of overtriage, while safely maintaining a low undertriage rate.
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