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Updated: Jan 28, 2026

Setting Up a Stroke Team Algorithm and Conducting Simulation-based Training in the Emergency Department - A Practical Guide
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Measuring what matters: Redefining undertriage using trauma team actions.

Samir M Fakhry1, Yan Shen, Alessandro Orlando

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|January 27, 2026
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Summary
This summary is machine-generated.

The High-Intensity Time-Sensitive (HITS) interventions method identified fewer undertriaged (UT) trauma patients and those at highest mortality risk compared to CMM and STAT methods. This data-driven approach streamlines UT rate calculation for quality improvement.

Keywords:
High-Intensity Time-Sensitive Interventions

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Area of Science:

  • Trauma care quality improvement
  • Emergency medicine research
  • Public health surveillance

Background:

  • Evaluating trauma triage efficiency, specifically undertriage (UT), is crucial for trauma centers.
  • Existing methods like Cribari Matrix Method (CMM) and Standardized Triage Assessment Tool (STAT) have limitations.
  • A novel method using High-Intensity Time-Sensitive (HITS) interventions is proposed for improved accuracy.

Purpose of the Study:

  • To compare the undertriage rates and mortality risk identification of CMM, STAT, and the novel HITS interventions method.
  • To determine the most effective method for identifying trauma patients who may have benefited from full trauma activation.

Main Methods:

  • A multicenter, retrospective study analyzed trauma registry data from 2017-2019.
  • Undertriage was assessed using CMM, STAT, and HITS interventions criteria.
  • Mortality risk in undertriaged patients was compared using multivariable generalized linear mixed models.

Main Results:

  • The HITS interventions method identified the lowest undertriage rate (3.8%) compared to STAT (5.1%) and CMM (11.1%).
  • HITS interventions showed a significantly higher adjusted odds ratio for mortality in undertriaged patients (15.04) versus CMM (6.67) and STAT (12.55).
  • The study included 158,696 patients across 37 trauma centers.

Conclusions:

  • The HITS interventions method offers a streamlined, data-driven approach to calculating undertriage rates.
  • This method effectively identifies undertriaged patients at the highest risk of mortality.
  • HITS interventions can guide performance improvement reviews by focusing on patients who may have benefited from full trauma activation.