A critical analysis of secondary overtriage to a Level I trauma center

Tang, Andrew; Hashmi, Ammar; Pandit, Viraj; Joseph, Bellal; Kulvatunyou, Narong; Vercruysse, Gary; Zangbar, Bardiya; Gries, Lynn; OʼKeeffe, Terence; Green, Donald P.; Friese, Randall S.; Rhee, Peter

doi:10.1097/ta.0000000000000462

Cited by 43 publications

(57 citation statements)

References 8 publications

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“…Although the literature reports a secondary overtriage rate between 6.9% and 39% [1, 9–11], the denominator previously used contains all transfer patients. The secondary overtriage population was compared to the transfer patients who were considered injured enough to consider the transfer appropriate.…”

Section: Discussionmentioning

confidence: 99%

“…This variability is due to the hospital’s infrastructure, human resources, and operational goals. In a regionalized trauma system, efficient allocation of resources is achieved through judicious centralization of resources [1]. Level one trauma centers serve as regional referral hospitals with the resources and commitment to care for the severely injured trauma patients, yet they do not see the entire trauma population of one particular region.…”

Section: Introductionmentioning

confidence: 99%

“…These are potentially unnecessary transfers and an analysis of these occurrences is useful to determine the efficiency of the trauma system as a whole. Few studies have addressed this phenomenon, with reported secondary overtriage rates between 39% and 6.9% [1, 9–11]. However, there has been little consensus in the methodologies and definitions for secondary overtriage.…”

Section: Introductionmentioning

confidence: 99%

“…Most definitions include a discharge time within 24–48h, with or without limiting the ISS to exclude the more severe injuries, and with or without excluding patients who had an operation. Most studies have been from single institutions comparing the rate of secondary overtriage using the total number of incoming transfers to that institution as the denominator [1, 9, 10]. An exception to the single institution studies was one done by Osen, in which selected all transferred trauma patients form the National Inpatient Sample, and they found the secondary overtriage rate to be 6.9% [11].…”

Section: Introductionmentioning

confidence: 99%

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Secondary overtriage in a statewide rural trauma system

Con

Long

Sasala

et al. 2015

Journal of Surgical Research

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Background Rural hospitals have variable degrees of involvement within the nationwide trauma system because of differences in resources and operational goals. “Secondary overtriage” refers to the patient who is discharged home shortly after being transferred from another hospital. An analysis of these occurrences is useful to determine the efficiency of the trauma system as a whole. Materials and methods Data was extracted from a statewide trauma registry from 2007–2012 to include those who were: 1) discharged home within 48h of arrival, and 2) did not undergo a surgical procedure. We then identified those who arrived as a transfer prior to being discharged (secondary overtriage) from those who arrived from the scene. Factors associated with transfers were analyzed using a logistic regression. Injuries were classified based on the need of a specific consultant. Time of arrival to ED was analyzed using 8-hour blocks, with the 7AM–3PM block as reference. Results 19,319 patients fit our inclusion criteria of which 1,897 (9.8%) arrived as transfers. Descriptive analysis showed a number of differences between transfers and non-transfers due to our large sample size. Thus, we examined variables that had more clinical significance using logistic regression controlling for age, ISS, the type of injury, blood products given, the time of arrival to initial ER, and whether a CT scan was obtained initially. Factors associated with being transferred were ISS>15, transfusion of PRBC’s, graveyard-shift arrivals, and neurosurgical, spine, and facial injuries. Patients having a CT scan were less likely to be transferred. Conclusions Secondary overtriage may result from the hospital’s limited resources. Some of these limitations are the availability of surgical specialists, blood products, and overall coverage during the “graveyard-shift.” More liberal use of the CT scan may prevent unnecessary transfers.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Secondary overtriage in a statewide rural trauma system

Con

Long

Sasala

et al. 2015

Journal of Surgical Research

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“…A review of existing triage literature demonstrated that severity of injury, need for surgical intervention, and hospital resources including intensive care units are common factors that affect facility determination [3,4,10,[12][13][14][15]. Additionally, length of stay after transfer has been previously utilized as an indicator of necessity for transfer.…”

Section: Study Populationmentioning

confidence: 97%

Secondary Overtriage in Pediatric Trauma: Can Unnecessary Patient Transfers Be Avoided?

Goldstein

Arendonk

Aboagye

et al. 2015

Journal of Pediatric Surgery

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Association of System-Level Factors With Secondary Overtriage in Trauma Patients

Parikh

Mamer

et al. 2019

JAMA Surg

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IMPORTANCE Studies show that secondary overtriage (SO) contributes significantly to the economic burden of injured patients; thus, the association of SO with use of the trauma system has been examined. However, the association of the underlying trauma system design with such overtriage has yet to be evaluated. OBJECTIVES To evaluate whether the distribution of trauma centers in a statewide trauma system is associated with SO and to identify clinical and demographic factors that may lead to SO. DESIGN, SETTING, AND PARTICIPANTS A retrospective cohort study was performed using 2008-2012 data from the Ohio Trauma and Emergency Medical Services registries. All patients taken to level III or nontrauma centers from the scene of the injury with an Injury Severity Score less than 15 and discharged alive were included. Among these patients, those with SO were identified as those who were subsequently transferred to a level I or II trauma center, had no surgical intervention, and were discharged alive within 48 hours of admission. The SO group was analyzed descriptively. Multiple logistic regression was used to identify system-level factors associated with SO. Statistical analysis was performed from August 1, 2017, to January 31, 2018. MAIN OUTCOMES AND MEASURES The primary outcome was the occurrence of SO. RESULTS Of 34 494 trauma patients able to be matched in the 2 registries, 7881 (22.9%) met the inclusion criteria, of whom 965 (12.2%) had SO. The median age in the SO group was 40 years (interquartile range, 26-55 years), with 299 women and 666 men. After adjusting for age, sex, comorbidities, injury type, and insurance status, the study found that system-level factors (number of level I or II trauma centers in the region [>1]) were significantly associated with SO (adjusted odds ratio, 1.98; 95% CI, 1.64-2.38; P < .001; area under the curve, 0.89). The reasons for choice of destination by emergency medical services (specifically, choosing the closest facility: adjusted odds ratio, 1.65; 95% CI, 1.37-1.98; P < .001) and use of a field trauma triage protocol (adjusted odds ratio, 2.21; 95% CI, 1.70-2.87; P < .001), significantly increased the likelihood of SO. CONCLUSIONS AND RELEVANCE This study's findings suggest that the distribution of major trauma centers in the region is significantly associated with SO. Subsequent investigation to identify the optimal number and distribution of trauma centers may therefore be critical. Specific outreach and collaboration of level III trauma centers and nontrauma centers with level I and II trauma centers, along with the use of telemedicine, may provide further guidance to level III trauma centers and nontrauma centers on when to transfer injured patients.

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A critical analysis of secondary overtriage to a Level I trauma center

Abstract: Epidemiologic study, level III.

Cited by 43 publications

References 8 publications

Secondary overtriage in a statewide rural trauma system

Secondary overtriage in a statewide rural trauma system

Secondary Overtriage in Pediatric Trauma: Can Unnecessary Patient Transfers Be Avoided?

Association of System-Level Factors With Secondary Overtriage in Trauma Patients

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