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Triage Accuracy and the 2015 Field Trauma Triage Criteria Update
Bourke W Tillmann1,2,3, Avery B Nathens3,4,5, Matthew P Guttman3,4
1Interdepartmental Division of Critical Care, University of Toronto, Toronto, Ontario, Canada.
JAMA Network Open
|January 6, 2026
Summary
Updated field trauma triage (FTT) guidelines initially reduced undertriage by 15% without increasing overtriage. However, undertriage rates gradually increased post-implementation, necessitating ongoing monitoring to sustain benefits.
Area of Science:
- Emergency Medicine
- Public Health
- Trauma Surgery
Background:
- Severely injured patients benefit from treatment at designated trauma centers, yet undertriage remains a significant issue.
- Field trauma triage (FTT) guidelines exist to aid pre-hospital assessment, but their impact on established triage patterns is unclear.
Purpose of the Study:
- To evaluate the association between the 2015 update of FTT guidelines and trauma triage trends in Ontario, Canada.
- To assess the impact of updated FTT guidelines on undertriage and overtriage rates in a mature trauma system.
Main Methods:
- Retrospective, population-based cohort study of adult trauma patients in Ontario from April 2009 to March 2020.
- Analysis of triage patterns before, during, and after the implementation of the 2015 FTT guidelines update.
- Interrupted time series analysis to assess changes in undertriage and overtriage rates, adjusting for patient and injury characteristics.
Main Results:
- The 2015 FTT guideline update was associated with an immediate 15.2% decrease in undertriage (RR, 0.85; 95% CI, 0.77-0.94).
- No significant immediate change in overtriage rates was observed (RR, 0.90; 95% CI, 0.79-1.04).
- Post-implementation, undertriage rates increased by 2.4% annually (RR, 1.02; 95% CI, 1.02-1.03), while overtriage decreased by 3.8% annually (RR, 0.96; 95% CI, 0.95-0.97).
Conclusions:
- Updated FTT guidelines effectively reduced undertriage upon implementation, without increasing overtriage.
- Sustained reduction in undertriage requires ongoing monitoring and potential guideline reinforcement.
- The study highlights the importance of continuous evaluation of triage protocols in trauma systems.
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