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Better compliance with triage criteria in trauma would reduced costs with maintained patient safety

Linder, Fredrika; Holmberg, Linaa; Eklöf, Hampusb; Björck, Martina; Juhlin, Claesa; Mani, Kevina

doi: 10.1097/MEJ.0000000000000544
Original article: PDF Only

Objective To evaluate trauma triage criteria in terms of compliance, undertriage, and overtriage and identify risk factors for mistriage.

Methods In a retrospective cohort study, all consecutive trauma patients at a University Hospital in Sweden in 2012 were included. Patients were stratified into three groups on the basis of trauma team activation (full trauma team, limited trauma team, and no trauma team). Case records were reviewed for mechanism of injury, vital signs, and injuries. Compliance with alert criteria was evaluated and injury severity score combined with the Matrix method was used for assessment of overtriage and undertriage.

Results A total of 1424 trauma patients were included in the study. Seventy-three (5.1%) patients activated a full trauma team, 732 (51.4%) a limited trauma team, and 619 (43.5%) did not activate any trauma team. Undertriage was 2.7% [95% confidence interval (CI): 1.9–3.8%] and overtriage was 34.2% (95% CI: 23.5–46.3%) in the complete cohort. Compliance with ‘trauma triage criteria’ was assessed by comparing actual alerts with what was estimated to be the correct alert levels on the basis of prehospital case records. Compliance with full trauma team criteria was 80% (68–88%), limited trauma team was 54% (51–58%), and no trauma team was 79% (76–82%). Assuming full compliance with trauma criteria, the Matrix method resulted in an undertriage of 2.3% (95% CI: 1.6–3.3%) and an overtriage of 42.6% (95% CI: 32.4–53.2%).

Conclusion The overtriage and undertriage in this study is in line with the recommendations of the American College of Surgeons Committee on Trauma. However, better compliance with trauma alert criteria would result in fewer trauma team activations without affecting patient safety.

This is an open-access article distributed under the terms of the Creative Commons Attribution-Non Commercial-No Derivatives License 4.0 (CCBY-NC-ND), where it is permissible to download and share the work provided it is properly cited. The work cannot be changed in any way or used commercially without permission from the journal.

aDepartment of Surgical Sciences, Section of Vascular Surgery

bDepartment of Surgical Sciences, Section of Radiology, Uppsala University, Uppsala, Sweden

Correspondence to Fredrik Linder, Ph Lic, Department of Surgical Sciences, Section of Vascular Surgery, Uppsala University, Akademiska sjukhuset, ing. 70 1tr, Uppsala 75185, Sweden Tel: +46 186 114 634; e-mail:

Received July 18, 2017

Accepted January 7, 2018

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