National analysis of over and under-triage rates in relation to trauma population risk factors and associated outcomes across various levels trauma centers

Introduction: Over and under-triage represent a misallocation of resources that can affect patient outcomes. The purpose of this study is to evaluate over and under-triage rates in relation to risk factors and associated outcomes of trauma patients nationwide.Methods: A retrospective cohort study using the Trauma Quality Improvement Program from 2017 to 2020. Multivariable regression models were used to assess predictors of over-triage (activation when unnecessary) and under-triage (limited activation when full activation was necessary).Results: 22.2 % (32,782) of the study population were over-triaged and 20.3 % (29,996) were under-triaged. Most over-triaged patients were Black, with Medicaid, or had a penetrating injury, whereas most under-triaged patients were White, with private/commercial insurance, or had a blunt injury. With covariates adjusted for, Pacific Islander (p = 0.024) and American Indian patients (p = 0.015) were associated with higher odds of over-triage, and Hispanic patients had higher odds of under-triage (p<0.001). Patients with Medicare (p<0.001) had higher odds of over-triage, and patients with private/commercial insurance (p<0.001) had higher odds of under-triage compared to Medicaid patients. Patients in level II (p<0.001) and level III (p<0.001) trauma hospitals were associated with higher odds of over-triage.Conclusion: Pacific Islander and American Indian patients, Medicare, and level II and III trauma centers are at increased risk of over-triage rates, while Hispanic and privately insured trauma patients had a higher risk for under-triage. Future studies should further investigate factors contributing to poor outcomes linked to undertriage practices and methods to improve consistency and standardization of triage tools across various levels of trauma centers.

Automated summary

This study evaluates the rates of over-triage and under-triage in trauma patients nationwide, as well as the associated risk factors and outcomes. The findings suggest that Pacific Islander and American Indian patients, Medicare beneficiaries, and patients treated at level II and III trauma centers are more likely to be over-triaged. Hispanic patients and privately insured patients, on the other hand, have a higher risk of under-triage.