Secondary Undertriage in a Rural Trauma System: A Retrospective Study of Twice-Transferred Patients

Undertriage is a metric of trauma system efficiency. In rural areas, field undertriage is a necessity due to long distances to other trauma centers. We investigated multiple transferred trauma patients from 2017 to 2020 to better understand secondary trauma triaging in a rural trauma system.

This was a retrospective cohort study. One hundred trauma patients were transferred multiple times before arrival to our level I trauma center between 2017 and 2020. Data were collected from our institution's trauma registry and medical records. Results were compared to a previous study from 1996 to 1999.

Eighty-seven eligible patients, 70 (80.5%) adults and 17 (19.5%) pediatric patients, were included. In comparison to 1996-1999, fewer trauma patients were twice transferred controlled for total trauma volume (3.0% versus 0.66%, P < 0.05). Patients were older (37.5 versus 47.1 years, P < 0.05) and less likely to be male compared to the original study (78.0 versus 62.1%, P < 0.05). Nearly 90% of adults first presented to state-verified level 4 trauma centers. Of those, 90.3% were transferred to a higher-level facility (Level 1: 14, Level 2: 14, and Level 3: 28).

Over the past 2 decades, the rate of secondary undertriage as measured by twice transferred trauma patients has declined significantly in our state. Further studies are warranted to understand the impact of multiple transfers on patient outcomes.