Increased mortality with undertriaged patients in a mature trauma center with an aggressive trauma team activation system

Rogers, Alan R.; Rogers, Frederick B.; Schwab, C. William; Bradburn, Eric H.; Lee, J.; Wu, Daniel; Miller, JoAnn

doi:10.1007/s00068-013-0289-z

Cited by 18 publications

(15 citation statements)

References 11 publications

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“…Undertriage is a medical problem, and failing to recognize a severely injured patient may lead to worse outcome. Patients on Warfarin, age more than 64 years, and patients with neurosurgical injuries are more likely to be undertriaged [12–14]. Although there is some evidence to suggest that falls at least 5 m are a relevant predictor of severe injury [15,16], our results show that patients with falls more than 3 m are undertriaged.…”

Section: Discussionmentioning

confidence: 69%

Better compliance with triage criteria in trauma would reduce costs with maintained patient safety

Linder

Holmberg

Eklöf

et al. 2019

European Journal of Emergency Medicine

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The overtriage and undertriage in this study is in line with the recommendations of the American College of Surgeons Committee on Trauma. However, better compliance with trauma alert criteria would result in fewer trauma team activations without affecting patient safety.This is an open-access article distributed under the terms of the Creative Commons Attribution-Non Commercial-No Derivatives License 4.0 (CCBY-NC-ND), where it is permissible to download and share the work provided it is properly cited. The work cannot be changed in any way or used commercially without permission from the journal. http://creativecommons.org/licenses/by-nc-nd/4.0/.

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Section: Discussionmentioning

confidence: 69%

Better compliance with triage criteria in trauma would reduce costs with maintained patient safety

Linder

Holmberg

Eklöf

et al. 2019

European Journal of Emergency Medicine

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“…The observed undertriage rate of 9.35% at our center during the study period is higher than the ACS goal undertriage rate of ≤5% 5. But it is difficult to compare the undertriage rates across studies owing to the differences in the definition of undertriage and institutional triage guidelines 20,24,25. Unfortunately, the ACS gives little guidance on the definition or process for review of undertriage patients within the confines of a multi-tiered system.…”

Section: Discussionmentioning

confidence: 99%

“…Determining these factors is especially important in safety-net hospitals, as they have been previously reported to be providing lower quality of care relative to non-safety-net hospitals 19. In addition, early detection of these risk factors while triaging could significantly improve the level of care provided, thereby improving patient outcomes and reducing mortality following severe trauma 20,21. Examining the demographics, injury characteristics, admission vitals, and mortality of trauma patients in a safety-net hospital could elucidate the risk factors that are most predictive of undertriage.…”

Section: Introductionmentioning

confidence: 99%

Risk factors and mortality associated with undertriage at a level I safety-net trauma center: a retrospective study

Barsi

Harris

Menaik

et al. 2016

OAEM

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PurposeThe primary objective of this study was to determine the risk factors associated with undertriage and the risk factors for mortality among the undertriaged patients at a level I safety-net trauma center.MethodsA retrospective analysis was performed of all trauma patients who presented to a level I safety-net trauma center with an injury severity score >15 over a 2-year period (2013–2014). Univariate and multivariate regression analyses were used to determine the risk factors predictive of undertriage in major trauma patients (injury severity score >15) and of mortality in undertriaged patients.ResultsDuring the 2-year study period, 334 of 2,485 admitted trauma patients presented with major trauma and were included in our study. From the univariate analysis, variables that were found to be independently associated with mortality in undertriaged patients included intubation, Glasgow Coma Scale score, revised trauma score, and dementia. Independent risk factors that were found to be significantly associated with undertriage in severely injured trauma patients included Glasgow Coma Scale score, motor vehicle crash, falls, revised trauma score, systolic blood pressure, heart rate, intubation, and dementia. When a multivariate analysis was performed to evaluate the statistically significant risk factors, dementia was found to be significantly associated with undertriage in severely injured trauma patients.ConclusionSeverely injured trauma patients with dementia are at significant risk for undertriage. Early identification of these risk factors while triaging at a level I safety-net trauma center could translate into improved patient outcomes following severe trauma.

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“…In this regard, since various factors can affect mortality in any traumatic incident,12, 13, 14 there is an increasing demand for local data on trauma, which includes not only mortality rates but also the factors involved in post-trauma mortality 15 . Early detection of these risk factors can significantly increase the quality of care and therefore lead to the improvement of patient outcomes and reduction of mortality caused by acute trauma 16, 17. Further advancements in this field would require data collection, planning and development of new strategies 10, 11.…”

Section: Introductionmentioning

confidence: 99%

A study of mortality risk factors among trauma referrals to trauma center, Shiraz, Iran, 2017

Yadollahi

2019

Chinese Journal of Traumatology

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Purpose Trauma is well known as one of the main causes of death and disability throughout the world. Identifying the risk factors for mortality in trauma patients can significantly improve the quality of care and patient outcomes, as well as reducing mortality rates. Methods In this retrospective cohort study, systematic randomization was used to select 849 patients referred to the main trauma center of south of Iran during a period of six months (February 2017–July 2017); the patients’ case files were evaluated in terms of demographic information, pre- and post-accident conditions, clinical conditions at the time of admission and finally, accident outcomes. A logistic regression model was used to analyze the role of factors affecting mortality among subjects. Results Among subjects, 60.4% were in the age-group of 15–39 years. There was a 10.4% mortality rate among patients and motor-vehicle accidents were the most common mechanism of injury (66.7%). Aging led to increased risk of fatality in this study. For each unit increase in Glasgow coma scale (GCS), risk of death decreased by about 40% (odds ratio ( OR ) = 0.63, 95% confidence interval ( CI ): 0.59–0.67). For each unit increase in injury severe score (ISS), risk of death increased by 10% ( OR = 1.11%, 95% CI : 1.08–1.14) and for each unit increase in trauma revised injury severity score (TRISS), there was 18% decrease in the risk of fatality ( OR = 0.82, 95% CI : 0.71–0.88). Conclusion The most common cause of trauma and the most common cause of death from trauma was traffic accidents. It was also found that an increase in the ISS index increases the risk of death in trauma patients, but the increase in GCS, revised trauma score (RTS) and TRISS indices reduces the risk of death in trauma patients. The TRISS indicator is better predictor of traumatic death than other indicators.

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Increased mortality with undertriaged patients in a mature trauma center with an aggressive trauma team activation system

Abstract: Standard trauma activation criteria may not be adequate to identify the at-risk severely injured trauma patient. Further refinement of in-house trauma triage protocols is necessary if trauma centers are to improve outcomes following trauma.

Cited by 18 publications

References 11 publications

Better compliance with triage criteria in trauma would reduce costs with maintained patient safety

Better compliance with triage criteria in trauma would reduce costs with maintained patient safety

Risk factors and mortality associated with undertriage at a level I safety-net trauma center: a retrospective study

A study of mortality risk factors among trauma referrals to trauma center, Shiraz, Iran, 2017

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