Predictive Factors for Undertriage Among Severe Blunt Trauma Patients: What Enables Them to Slip Through an Established Trauma Triage Protocol?

Abstract

Background: Although various trauma triage protocols have been developed to reduce undertriage with acceptable overtriage, risk factors for undertriage have rarely been examined. The objective of this study was to determine factors that can predict undertriage. Study Design: The study involved blunt trauma patients aged ≥15 years admitted to a critical care medical center, equivalent to a level one trauma center, from its catchment area (two medical districts in southern Osaka, Japan) from October 2001 to September 2004, who had at least one severe injury with an Abbreviated Injury Scale score of ≥3 (N = 396). We compared patients who were directly transported to the center with patients who were transferred to the center from non-critical care medical center hospitals. Results: Age of 45 years to 54 years (odds ratio [OR], 6.76), Injury Severity Score of ≥16 (OR = 3.67), Glasgow coma scale score of 13 to 15 (OR = 4.79), and nighttime (OR = 2.31) were significantly associated with a higher risk of undertriage. Chest injuries (OR = 0.40) and lower limb injuries (OR = 0.26) were significantly associated with a lower risk of undertriage. Among patients with a single injury, isolated head injuries (OR = 9.10) and pelvic injuries (OR = 14.2) were associated with a higher risk of undertriage. Conclusions: Injury characteristics (severe injuries, and head and pelvic injuries), patients' characteristics (middle-aged and conscious), and time of day (nighttime) are predictive factors for undertriage. Suggested improvements in the triage protocol include changing the age criteria, flexible application of the protocol at night, training of paramedics to identify easily missed injuries, and inclusion of predictive factors for such injuries into the protocol.