Factors associated with an increased likelihood of secondary overtriage of injured patients include the emergency services’ choice of care destination, as well as the use of a field trauma triage protocol, according to study results published in JAMA Surgery.

Data from the Ohio Trauma and Emergency Medical Services registries (2008 to 2012) were pooled to create a retrospective cohort of patients receiving care at level III or non-trauma centers (N=7881). Patients were taken to these centers from the scene of injury, with an Injury Severity Score <15. All patients were discharged alive.

Study investigators also identified patients with secondary overtriage (n=965; median age, 40 [interquartile range, 26 to 55]), patients who were transferred to a level I or II trauma facility, patients with no surgical intervention, and patients discharged alive within 48 hours of hospital admission. For the purposes of their analysis, the researchers focused on identifying system-level factors associated with secondary overtriage.

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In the analysis adjusted for age, sex, comorbidities, injury type, and insurance status, researchers found that the number of level I or II trauma centers in the region (>1) was associated with secondary overtriage (adjusted odds ratio [aOR], 1.98; 95% CI, 1.64-2.38; P <.001). Factors associated with increasing the likelihood of secondary overtriage also included emergency medical services choosing the closest facility for care (aOR, 1.65; 95% CI, 1.37-1.98; P <.001) and the use of a field trauma triage protocol (aOR, 2.21; 95% CI, 1.70-2.87; P <.001).Limitations of the study include its retrospective design, as well as the potential lack of generalizability across centers outside of Ohio.

“Subsequent investigation to identify the optimal number and distribution of trauma centers may therefore be critical,” the researchers concluded. “Specific outreach and collaboration of level III trauma centers and non-trauma centers with level I and II trauma centers, along with the use of telemedicine, may provide further guidance to level III trauma centers and non-trauma centers on when to transfer injured patients.”


Parikh PP, Parikh P, Mamer L, McCarthy MC, Sakran JV. Association of system-level factors with secondary overtriage in trauma patients [published online September 19, 2018]. JAMA Surg. doi:10.1001/jamasurg.2018.3209