Overtriage in trauma – what are the causes?

Uleberg, Oddvar; Vinjevoll, Ole-Petter; Eriksson, Urs; Aadahl, Petter; Skogvoll, Eirik

doi:10.1111/j.1399-6576.2007.01414.x

Cited by 61 publications

(69 citation statements)

References 21 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Our results are in line with several other studies that report an overtriage of ca 70 % [5–9]. Some authors report overtriage as high as 90 % [16], and in this context our results may still be acceptable.…”

Section: Discussionsupporting

confidence: 93%

See 1 more Smart Citation

Evaluation of a trauma team activation protocol revision: a prospective cohort study

Dehli

Monsen²,

Fredriksen

et al. 2016

Scand J Trauma Resusc Emerg Med

View full text Add to dashboard Cite

BackgroundCorrect triage based on prehospital information contributes to a better outcome for potentially seriously injured patients. In 2011 we changed the trauma team activation (TTA) criteria in our center in order to improve the high over- and undertriage properties of the protocol. Five criteria that were unable to predict severe injury were removed. In the present study, we evaluated the protocol revision by comparing over- and undertriage in the former and present set of criteria.MethodsAll severely injured patients (Injury Severity Score (ISS) > 15) and all patients admitted with TTA in the period of 01.01.2013 – 31.12.2014 were included in the study. We defined overtriage as the fraction of patients with TTA when ISS ≤15 and undertriage as the fraction of patients without TTA when ISS > 15. We also evaluated triage with the occurrence of emergency procedures immediately after admission.Results324 patients were included, 164 patients had ISS>15, 287 were admitted with TTA. Over- and undertriage were 74 % and 28 % respectively. When we used emergency procedure as reference, the figures were 83 % and 15 % respectively. Undertriaged patients had significantly more neurosurgical injuries and were significantly more often transferred from an acute care hospital.DiscussionOver- and undertriage are almost the same as before the criteria were revised, and higher thanrecommended levels.ConclusionsRevision of the TTA criteria has not improved triage, and further measures are necessary to achieveacceptable levels.

show abstract

Section: Discussionsupporting

confidence: 93%

“…A substantial overtriage (TTA despite only minor or moderate injury) is common and may reach 70 % in some centers, mostly reflecting a low specificity of the MOI criteria [5–7]. Overtriage is mainly a resource problem, as it diverts personnel from other activities in the hospital.…”

Section: Introductionmentioning

confidence: 99%

Evaluation of a trauma team activation protocol revision: a prospective cohort study

Dehli

Monsen²,

Fredriksen

et al. 2016

Scand J Trauma Resusc Emerg Med

View full text Add to dashboard Cite

show abstract

“…The overtriage of uninjured or minimally injured patients can result in significant wasted costs and resources, inappropriate and unnecessary patient interventions and imaging, unnecessary disruption of ED and OR work flow, and can contribute to significant provider-level dissatisfaction with the trauma system and providing trauma coverage. 5,6,15 In the current era of crisis regarding healthcare costs, shortages of personnel willing to provide trauma coverage, and declining resident interest in careers in trauma, the problem of overtriage should warrant closer inspection.…”

Section: Commentsmentioning

confidence: 99%

“…The result has been an acceptance of overtriage rates well above 50% as a ''necessary evil'' of avoiding undertriage and missed significant injuries. 5,6 Although the negative impacts of undertriage have been well described, there has been much less investigation of the potential negative impacts or burden of high overtriage rates. The most obvious of these is a waste of resources, including personnel, time, and equipment, on a patient with minimal or no injuries.…”

mentioning

confidence: 99%

A simplified trauma triage system safely reduces overtriage and improves provider satisfaction: a prospective study

Shawhan

McVay

Casey

et al. 2015

The American Journal of Surgery

View full text Add to dashboard Cite

“…To achieve optimal delivery of care and to maximize patient safety, triage processes in emergency medicine seek to minimize under-triage (to reduce preventable morbidity and mortality) while keeping over-triage low (to enhance efficiency; Uleberg et al, 2007;Lehmann et al, 2009;Xiang et al, 2014;Shawhan et al, 2015). The temptation to over-triage is often exaggerated when long wait times may result in increased harm (Aacharya et al, 2011), if there is emotional involvement or high possibility of litigation (Pou, 2013), or if there is institutional or financial incentive to do so (FitzGerald et al, 2010).…”

Section: Uncertainty Necessitates Consideration Of Risk Preferences mentioning

confidence: 99%

Ethics of Conservation Triage

Wilson

Law

2016

Front. Ecol. Evol.

View full text Add to dashboard Cite

Conservation triage seems to be at a stalemate between those who accept triage based on utilitarian rationalization, and those that reject it based on a number of ethical principles. We argue that without considered attention to the ethics of conservation triage we risk further polarization in the field of conservation. We draw lessons from the medical sector, where triage is more intuitive and acceptable, and also from disaster planning, to help navigate the challenges that triage entails for conservation science, practice, and policy. We clarify the consequentialist, deontological, and virtue ethical stances that influence the level of acceptance of triage. We emphasize the ethical dimensions of conservation triage in principle and in practice, particularly in the context of stakeholder diversity, a wide range of possible objectives and actions, broader institutions, and significant uncertainties. A focus on a more diverse set of ethics, more considered choice of triage as a conservation tool, open communication of triage objectives, and protocols, greater consideration of risk preferences, and regular review and adaptation of triage protocols is required for conservation triage to become more acceptable among diverse conservation practitioners, institutions, and the general public. Accepting conservation triage as fundamentally an ethical problem would foster more open dialog and constructive debate about the role of conservation triage in a wider system of care.

show abstract

Overtriage in trauma – what are the causes?

Abstract: A TTA protocol based on physiological, anatomical and interfacility transfer criteria seems to yield a higher precision than, in particular, that based on mechanism of injury criteria. Because of substantial overtriage in our hospital, the TTA protocol needs to be re-evaluated.

Cited by 61 publications

References 21 publications

Evaluation of a trauma team activation protocol revision: a prospective cohort study

Evaluation of a trauma team activation protocol revision: a prospective cohort study

A simplified trauma triage system safely reduces overtriage and improves provider satisfaction: a prospective study

Ethics of Conservation Triage

Contact Info

Product

Resources

About