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Area of Science:

  • Trauma Surgery
  • Emergency Medicine
  • Public Health

Background:

  • Trauma team activation (TTA) criteria identify high-risk patients for optimal resource allocation.
  • Undertriage occurs when severely injured patients do not meet TTA criteria, potentially delaying care.
  • This study investigates the characteristics and outcomes of undertriaged patients.

Purpose of the Study:

  • To examine the epidemiology and injury patterns of undertriaged patients.
  • To identify a high-risk subgroup of undertriaged patients.
  • To evaluate the clinical effects and outcomes of undertriage.

Main Methods:

  • A Level I trauma center screened patients using modified TTA criteria (mTTA) including age >70.
  • Demographics, injury data, and outcomes of undertriaged patients were analyzed.
  • Undertriaged patients were subcategorized as 'high-risk' if they expired or required emergent intervention.

Main Results:

  • 16% of trauma consults involved undertriaged patients (n=233), with a mean Injury Severity Score of 20.
  • Blunt trauma, especially motor vehicle collisions, was the most common mechanism.
  • High-risk undertriaged patients (n=32) had high mortality (44%) and emergent intervention rates, primarily due to severe traumatic brain injury (TBI).

Conclusions:

  • Modified TTA criteria identify a low rate of undertriage, but a significant high-risk population is missed.
  • Severe TBI is the leading cause of death in undertriaged patients.
  • Patients with head trauma and low Glasgow Coma Scale scores (<11) on arrival warrant consideration for increased resource mobilization.