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Triage in an established trauma system

M J Zimmer-Gembeck1, P A Southard, J R Hedges

  • 1Trauma Program, Oregon Health Sciences University, Portland 97201, USA.

The Journal of Trauma
|November 1, 1995
PubMed
Summary
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Elderly patients with severe injuries face undertriage in trauma systems, while intoxicated or obese patients with minor injuries risk overtriage. Identifying these patient characteristics is crucial for improving trauma care.

Area of Science:

  • Emergency Medicine
  • Trauma Surgery
  • Public Health

Background:

  • Accurate triage of trauma patients is essential for optimal outcomes.
  • Undertriage and overtriage of trauma patients can lead to adverse events and resource misallocation.

Purpose of the Study:

  • To identify patient and injury characteristics associated with undertriage and overtriage in a developed trauma system.
  • To inform strategies for improving the accuracy of pre-hospital trauma triage.

Main Methods:

  • Retrospective analysis of 26,025 acute injury admissions over 2.5 years.
  • Conversion of ICD-9 codes to Injury Severity Scores (ISS) for patient stratification.
  • Statistical analysis to determine predictors of undertriage and overtriage.

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Main Results:

  • Seventy-nine percent of severely injured patients were appropriately triaged to Level I trauma centers.
  • Elderly patients (OR=5.44) and those with non-multisystem injuries (OR=0.55) were more likely to be undertriaged.
  • Twenty-five percent of minor injury patients were overtriaged, with intoxication, obesity, and head/face injuries being common characteristics.

Conclusions:

  • Elderly trauma patients, particularly females, are at increased risk of undertriage within established trauma systems.
  • Patient factors such as intoxication and obesity, along with specific injury patterns, highlight challenges in prospective out-of-hospital triage.
  • Findings underscore the need for refined triage protocols to minimize both undertriage and overtriage.