Undertriaged trauma patients: Who are we missing?
The journal of trauma and acute care surgery · 2019-06-18 · Observational study
Abstract
BACKGROUND: Trauma team activation (TTA) criteria, set by the American College of Surgeons Committee on Trauma, are used to identify patients prehospital who are at highest risk for severe injury and mobilize the optimal resources. Patients are undertriaged if they are severely injured (Injury Severity Score, ≥16) but do not meet TTA criteria. This study examined the epidemiology and injury patterns of undertriaged patients and potential clinical effects. METHODS: All patients presenting to our Level I trauma center (June 1, 2017 to May 31, 2018) were screened for inclusion using modified TTA criteria (mTTA), that is, age over 70 years added to the standard American College of Surgeons Committee on Trauma TTA criteria. Demographics, injury/clinical data, and outcomes of undertriaged patients were analyzed. Undertriaged patients were further subcategorized as "high-risk" if they expired or required emergent intervention. RESULTS: 233 undertriaged patients were identified from 1423 routine trauma consults (16%). Mean Injury Severity Score was 20 (range, 16-43). Most undertriage occurred following blunt trauma (n = 224, 96%), especially motor vehicle collisions (n = 66, 28%) and auto versus pedestrian collisions (n = 57, 24%). Thirty-two (14%) patients were identified as high-risk undertriaged patients: 16 (50%) required emergency surgery (mainly craniectomy; n = 10, 63%), 5 (16%) required angioembolization, and 14 patients (44%) died. In this high-risk group, the cause of death was almost exclusively traumatic brain injury (TBI) (n = 13, 93%). Of the patients who died of TBI, the majority had a depressed Glasgow Coma Scale score on presentation to the ED (<11) (n = 10, 77%) despite not meeting field criteria for TTA. CONCLUSION: Using mTTA criteria, undertriage rates are relatively low, particularly after penetrating trauma. However, there is a high-risk population that is not captured, among whom mortality and need for emergent intervention are high. Most undertriage deaths are secondary to severe TBI. Despite not qualifying for highest-level activation, patients with head trauma and Glasgow Coma Scale score less than 11 on admission are at high-risk for adverse outcomes and additional resource mobilization should be considered. LEVEL OF EVIDENCE: Care Management, level IV.
Abstract © the authors or publisher, via PubMed. Reuse and removal
Tags
Mortality & survival · Older adults · Triage instruments
Related articles
- Evaluating performance and potential clinical benefit of the Swedish On Scene Injury Severity Prediction (OSISP) model for prehospital field triage on Norwegian trauma data. (Scand J Trauma Resusc Emerg Med, 2026)
- Evaluation of the New South Wales ambulance T1 major trauma transport protocol: A state-wide data linkage study. (Injury, 2023)
- Accuracy of a Prehospital Triage Protocol in Predicting In-Hospital Mortality and Severe Trauma Cases among Older Adults. (Int J Environ Res Public Health, 2023)
- Should we still use motor vehicle intrusion as a sole triage criterion for the use of trauma center resources? (Injury, 2016)
- Systolic blood pressure criteria in the National Trauma Triage Protocol for geriatric trauma: 110 is the new 90. (J Trauma Acute Care Surg, 2015)
- Advancing age and trauma: triage destination compliance and mortality in Victoria, Australia. (Injury, 2014)