title: Risk factors and mortality associated with undertriage at a level I safety-net trauma center: a retrospective study.
abstract: OBJECTIVE
  The primary objective of this study was to determine the risk factors associated with undertriage and the risk factors for mortality among the undertriaged patients at a level I safety-net trauma center.
  
  
  METHODS
  A retrospective analysis was performed of all trauma patients who presented to a level I safety-net trauma center with an injury severity score >15 over a 2-year period (2013-2014). Univariate and multivariate regression analyses were used to determine the risk factors predictive of undertriage in major trauma patients (injury severity score >15) and of mortality in undertriaged patients.
  
  
  RESULTS
  During the 2-year study period, 334 of 2,485 admitted trauma patients presented with major trauma and were included in our study. From the univariate analysis, variables that were found to be independently associated with mortality in undertriaged patients included intubation, Glasgow Coma Scale score, revised trauma score, and dementia. Independent risk factors that were found to be significantly associated with undertriage in severely injured trauma patients included Glasgow Coma Scale score, motor vehicle crash, falls, revised trauma score, systolic blood pressure, heart rate, intubation, and dementia. When a multivariate analysis was performed to evaluate the statistically significant risk factors, dementia was found to be significantly associated with undertriage in severely injured trauma patients.
  
  
  CONCLUSIONS
  Severely injured trauma patients with dementia are at significant risk for undertriage. Early identification of these risk factors while triaging at a level I safety-net trauma center could translate into improved patient outcomes following severe trauma.
authors.affiliation: Department of Emergency Medicine, Nassau University Medical Center, East Meadow, NY, USA.
authors.forename: Chris
authors.initials: C
authors.lastname: Barsi
authors.affiliation: Department of Emergency Medicine, Nassau University Medical Center, East Meadow, NY, USA.
authors.forename: Peter
authors.initials: P
authors.lastname: Harris
authors.affiliation: Department of Emergency Medicine, Nassau University Medical Center, East Meadow, NY, USA.
authors.forename: Rich
authors.initials: R
authors.lastname: Menaik
authors.affiliation: Department of Emergency Medicine, Nassau University Medical Center, East Meadow, NY, USA.
authors.forename: Nicholas C
authors.initials: NC
authors.lastname: Reis
authors.affiliation: Department of Emergency Medicine, Nassau University Medical Center, East Meadow, NY, USA.
authors.forename: Swapna
authors.initials: S
authors.lastname: Munnangi
authors.affiliation: Department of Emergency Medicine, Nassau University Medical Center, East Meadow, NY, USA.
authors.forename: Mikhail
authors.initials: M
authors.lastname: Elfond
keywords: dementia; injury severity score; multi-tier trauma team activation; trauma activation guidelines