title: A critical analysis of secondary overtriage to a Level I trauma center.
abstract: BACKGROUND
  Trauma centers often receive transfers from lower-level trauma centers or nontrauma hospitals. The aim of this study was to analyze the incidence and pattern of secondary overtriage to our Level I trauma center.
  
  
  METHODS
  We performed a 2-year retrospective analysis of all trauma patients transferred to our Level I trauma center and discharged within 24 hours of admission. Reason for referral, referring specialty, mode of transport, and intervention details were collected. Outcomes measures were incidence of secondary overtriage as well as requirement of major or minor procedure. Major procedure was defined as surgical intervention in the operating room. Minor procedures were defined as procedures performed in the emergency department.
  
  
  RESULTS
  A total of 1,846 patients were transferred to our Level I trauma center, of whom 440 (24%) were discharged within 24 hours of admission. The mean (SD) age was 35 (21) years, 72% were male, and mean (SD) Injury Severity Score (ISS) 4 (4). The most common reasons for referral were extremity fractures (31%), followed by head injury (23%) and soft tissue injuries (13%).Of the 440 patients discharged within 24 hours, 380 (86%) required only observation (268 of 380) or minor procedure (112 of 380). Minor procedures were entirely consisted of fracture management (n = 47, 42%) and wound care (n = 65, 58%). The mean (SD) interfacility transfer distance was 45 (46) miles. Mean (SD) hospital charges per transfer were $12,549 ($5,863).
  
  
  CONCLUSIONS
  A significant number of patients transferred to our trauma center were discharged within 24 hours; most of them required observation and/or minor procedures. Appropriately increasing primary hospital resources, in addition to interhospital outreach in the form of education or telemedicine, should be considered to decrease the number of avoidable transfers.
  
  
  METHODS
  Epidemiologic study, level III.
authors.affiliation: From the Division of Trauma, Critical Care, Emergency Surgery, and Burns, Department of Surgery, University of Arizona, Tucson, Arizona.
authors.forename: Andrew
authors.initials: A
authors.lastname: Tang
authors.forename: Ammar
authors.initials: A
authors.lastname: Hashmi
authors.forename: Viraj
authors.initials: V
authors.lastname: Pandit
authors.forename: Bellal
authors.initials: B
authors.lastname: Joseph
authors.forename: Narong
authors.initials: N
authors.lastname: Kulvatunyou
authors.forename: Gary
authors.initials: G
authors.lastname: Vercruysse
authors.forename: Bardiya
authors.initials: B
authors.lastname: Zangbar
authors.forename: Lynn
authors.initials: L
authors.lastname: Gries
authors.forename: Terence
authors.initials: T
authors.lastname: O'Keeffe
authors.forename: Donald
authors.initials: D
authors.lastname: Green
authors.forename: Randall
authors.initials: R
authors.lastname: Friese
authors.forename: Peter
authors.initials: P
authors.lastname: Rhee
mesh_terms: D000328:Adult; D005260:Female; D050723:Fractures, Bone / Q000175:diagnosis / Q000628:therapy; D006801:Humans; D015601:Injury Severity Score; D008297:Male; D017063:Outcome Assessment, Health Care; D010351:Patient Discharge / Q000706:statistics & numerical data; D012017:Referral and Consultation / Q000706:statistics & numerical data; D012189:Retrospective Studies; D013997:Time Factors; D014193:Trauma Centers / Q000706:statistics & numerical data; D014218:Triage / Q000379:methods* / Q000706:statistics & numerical data; D014947:Wounds and Injuries / Q000175:diagnosis / Q000628:therapy