Evaluation of the trauma triage accuracy in a Level 1 Australian trauma centre

To assess the rate of undertriage of major trauma patients and to assess factors contributing to undertriage in a modern Australian Level 1 trauma centre.

A retrospective case series of 600 consecutive major trauma (injury severity score [ISS] >15) patients admitted to Royal Perth Hospital (RPH) during 2015 was performed. Data were compiled via the prospectively maintained hospital trauma registry for all patients admitted with a major trauma during the study period. Results were analysed for patient demographics, mechanism and outcomes. The primary outcome of the study was to determine the rate of undertriage of major trauma at RPH by establishing whether or not the trauma team activation page was correctly sent at the time of patient arrival based on hospital criteria.

The average age of patients in the study population was 46.5 (±21.5) years and the mean ISS was 24.7 (±9.3). The most common mechanism of injury was falls, motor vehicle accidents and motorbike accidents. One hundred and sixty-nine patients (28%) did not have trauma team activation on arrival to the ED. Among these patients, 132 did not fulfil the RPH trauma activation criteria. The remaining 37 patients (6.1%) did meet the criteria and were considered undertriaged. Subgroup analysis showed a statistically significant difference in age between the patients who had trauma team activation (42.7 ± 19.5 years) and those who did not (55.9 ± 23.3 years).

In this cohort of major trauma, a 6.1% undertriage performance of the triage tool was observed. Sub-analysis of the data showed that elderly patients were more likely to be undertriaged.