Evaluation of Secondary Overtriage at a Rural Level 1 Trauma Center

Area of Science:

• Trauma surgery
• Healthcare systems research
• Patient transfer protocols

Background:

• Secondary overtriage (SO) occurs when patients are transferred to a higher level of care than necessary.
• Understanding SO prevalence is crucial for optimizing trauma system resource allocation.
• Rural healthcare systems face unique challenges in managing patient transfers.

Purpose of the Study:

• To determine the prevalence of secondary overtriage (SO) in a rural Appalachian healthcare system.
• To analyze the characteristics of patients experiencing SO.
• To identify potential areas for improving trauma transfer protocols.

Main Methods:

• Retrospective analysis of trauma registry data from 2017-2022.
• Stratification of transfer patients into SO and non-SO groups based on Injury Severity Score (ISS), operative intervention, and discharge time.
• Comparison of demographic data, length of stay, and injury severity between groups.

Main Results:

• 43% of 3,291 trauma transfer patients met the criteria for SO.
• SO patients were younger, had shorter hospital and ICU stays, and lower ISS.
• Head/neck injuries (AIS ≥3) occurred in 8.96% of SO patients; facial injuries occurred in 21%.

Conclusions:

• A significant proportion of trauma transfers in this rural system were classified as SO.
• Minimizing SO can improve patient outcomes and conserve healthcare resources.
• Institutional analysis of transfer data is recommended to refine protocols and reduce overtriage.