Triage in an established trauma system.
OBJECTIVE
The goal of this study was to determine patient and injury characteristics that predict undertriage and overtriage.


METHODS
This study was a retrospective analysis of admissions for acute injury.


METHODS
All admissions for acute injuries in a 2 1/2-year period were included (N = 26,025). ICD-9 clinical modification codes were converted to Injury Severity Scores.


RESULTS
Seventy-nine percent of severely injured patients were admitted to level I trauma centers. Severely injured patients admitted to other hospitals (undertriage) were more likely elderly (odds ratio = 5.44) and less likely had multisystem injuries (odds ratio = 0.55). One-fourth of patients with minor injuries were admitted to level I trauma centers (overtriage). Overtriaged patients were more likely intoxicated, obese, or had an injury to the head or face.


CONCLUSIONS
In a developed trauma system, severely injured elderly trauma patients (especially females) are at risk for undertriage. The characteristics of patients at risk for overtriage reflect the difficulties of prospective out-of-hospital triage.
D000328:Adult; D000368:Aged; D004632:Emergency Medical Services / Q000458:organization & administration; D005260:Female; D006760:Hospitalization; D006801:Humans; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009922:Oregon; D012189:Retrospective Studies; D014193:Trauma Centers / Q000706:statistics & numerical data; D014218:Triage / Q000379:methods*; D014947:Wounds and Injuries / Q000145:classification*