A comprehensive analysis of undertriage in a mature trauma system using geospatial mapping

Area of Science:

• Trauma systems research
• Geospatial analysis in healthcare
• Public health epidemiology

Background:

• Effective triage of trauma patients to appropriate trauma centers (TCs) is critical for patient outcomes.
• Undertriage (UTR) remains a challenge in trauma care systems.
• Understanding spatial patterns of UTR is essential for resource allocation.

Purpose of the Study:

• To determine the percentage of undertriaged patients in the Pennsylvania (PA) trauma system.
• To spatially analyze areas of undertriage across pediatric, adult, and geriatric populations in PA.
• To identify geographic patterns associated with undertriage.

Main Methods:

• Analysis of Pennsylvania Trauma Systems Foundation and PHC4 registry data (2003-2015).
• Categorization of patients into pediatric (<15), adult (15-64), and geriatric (≥65) age groups.
• Geospatial mapping of undertriage rates by zip code tabulation area (ZCTA) using ArcGIS and GeoDa.
• Statistical analysis using Stata.

Main Results:

• Significant percentages of undertriage were observed across all age groups.
• High UTR rates were identified in rural areas, particularly in central PA with limited TC access.
• Areas with TCs near large non-trauma centers also exhibited high undertriage.

Conclusions:

• Two primary patterns contribute to undertriage: proximity to competing non-trauma centers and lack of access to TCs.
• Geospatial mapping is a valuable tool for identifying areas needing focused resources to reduce undertriage.
• Targeted interventions in identified high-UTR zones can improve trauma care delivery.