ThP7.7 - Investigating Trauma Patient Undertriage in Riyadh's Prehospital System

Abstract

Abstract Aims This study aims to analyze the extent of prehospital undertriage by assessing the transfer rates of critically ill trauma patients to non-trauma centers in Riyadh, Saudi Arabia. Methods We analyzed 102,895 incident reports from 50 prehospital dispatch centers in Riyadh using data from the Saudi Red Crescent Authority between January 2021 and March 2023. Inclusion criteria comprised all adult trauma cases classified under red criteria. We mapped regional distribution and delineated trauma center service areas reachable within specific timeframes using QGIS. Dispatch centers were grouped based on these service areas to evaluate undertriage. Data analysis was performed using SPSS 26 and R statistics. Results Approximately a third of the red criteria cases (n=5105/17983, 28.8%) were undertriaged to a non-trauma center primarily involving blunt traumatic injuries (n=3316, 65%) and, to a lesser degree, penetrating injuries (n=1604, 31.4%). Undertriage rates were higher in the 45- and 60-minute service areas (n=930/2917, 31.9% and n=20/45, 44.4%, respectively), particularly in the east (n=2013/5105, 39.4%) and north (n=1522/5105, 29.8%). Nearly a third of undertriaged cases (n=1601/5105, 31.4%) experienced delays, ranging from 4.5% to 66.8% across dispatch centers. The highest undertriage rates were observed in specific dispatch centers, such as Alkharj and Alamana, located in the 30- and 45-minute service areas, respectively. Conclusions The study reveals higher undertriage rates in areas farther from trauma centers, indicating a greater likelihood of non-trauma center transfers. To enhance access to trauma care for critically ill patients, there is a need for infrastructure expansion and stricter implementation of triaging protocols. Further research should investigate the impact of non-trauma center transfers on mortality in the region.