Factors associated with undertriage of trauma patients at level 1 trauma center

Background: Applying American College of Surgeons Trauma Team Activation (TTA) criteria could improve trauma system outcomes and minimize both overtriage and undertriage of trauma patients. However, a percentage of trauma patients might slip through the system and become undertriaged. Objective: The objective of the study is to investigate factors related to undertriage of trauma patients at level 1 trauma center. Design: This was a retrospective cohort study. Setting and Subjects: We included all trauma patients at a level 1 trauma center from January 1, 2016, to December 31, 2019. Methods and Main Outcome Measures: We compared those who received TTA after 5 min of their arrival to emergency department (ED) (undertriaged cohort) to those who received no TTA (properly triaged cohort) in terms of demographic, anatomical, and physiological factors as well as injury severity assessment. Results: A total of 3740 trauma patients were included; 3330 (89%) were appropriately triaged and needed no TTA while 410 (10.9%) were undertriaged. In multivariate logistic regression model, the following factors were significantly associated with undertriage: arriving to ED in weekends (odd ratio, 1.417, confidence interval [CI] 95%, 1.047–1.916), motorcycle accidents (odds ratio, 3.709, 95% CI, 1.422–9.671), pedestrian victims (odds ratio, 7.477, 95% CI, 3.048–18.341), heart rate <60 (odds ratio, 2.657, 95% CI, 1.083–6.522), systolic blood pressure 76–89 (odds ratio, 4.235, 95% CI, 1.596–11.235), and Glasgow coma scale 9–12 (odds ratio, 4.365, 95% CI, 2.747–6.936). Conclusion: This study displayed different factors predictive of delayed TTA. Recognizing these factors could improve patient outcomes. Limitations: Poor prehospital documentation and communication from emergency medical services and a large number of missing data.