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Undertriage of older trauma patients: is this a national phenomenon?

  • Lisa M. Kodadek
    Correspondence
    Corresponding author. Center for Surgical Trials and Outcomes Research, Department of Surgery, Johns Hopkins University School of Medicine, 600 N Wolfe Street, Blalock 611, Baltimore, MD 21287. Tel.: +1 443 287 6567; fax: +1 410 955 8101.
    Affiliations
    Center for Surgical Trials and Outcomes Research, Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
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  • Author Footnotes
    1 Permanent address: Hugo W. Moser Research Institute, Kennedy Krieger Institute, 716 N Broadway Street, Suite 403, Baltimore, MD 21205.
    Shalini Selvarajah
    Footnotes
    1 Permanent address: Hugo W. Moser Research Institute, Kennedy Krieger Institute, 716 N Broadway Street, Suite 403, Baltimore, MD 21205.
    Affiliations
    Center for Surgical Trials and Outcomes Research, Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
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  • Catherine G. Velopulos
    Affiliations
    Center for Surgical Trials and Outcomes Research, Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
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  • Elliott R. Haut
    Affiliations
    Division of Trauma and Acute Care Surgery, Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
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  • Author Footnotes
    2 Permanent address: Center for Surgery and Public Health, Department of Surgery, Brigham and Women's Hospital, One Brigham Circle, 1620 Tremont Street, 4-020, Boston, MA 02120.
    Adil H. Haider
    Footnotes
    2 Permanent address: Center for Surgery and Public Health, Department of Surgery, Brigham and Women's Hospital, One Brigham Circle, 1620 Tremont Street, 4-020, Boston, MA 02120.
    Affiliations
    Center for Surgical Trials and Outcomes Research, Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
    Search for articles by this author
  • Author Footnotes
    1 Permanent address: Hugo W. Moser Research Institute, Kennedy Krieger Institute, 716 N Broadway Street, Suite 403, Baltimore, MD 21205.
    2 Permanent address: Center for Surgery and Public Health, Department of Surgery, Brigham and Women's Hospital, One Brigham Circle, 1620 Tremont Street, 4-020, Boston, MA 02120.

      Abstract

      Background

      Older age is associated with high rates of morbidity and mortality after injury. Statewide studies suggest significantly injured patients aged ≥55 y are commonly undertriaged to lower level trauma centers (TCs) or nontrauma centers (NTCs). This study determines whether undertriage is a national phenomenon.

      Materials and methods

      Using the 2011 Nationwide Emergency Department Sample, significantly injured patients aged ≥55 y were identified by diagnosis and new injury severity score (NISS) ≥9. Undertriage was defined as definitive care anywhere other than level I or II TCs. Weighted descriptive analysis compared characteristics of patients by triage status. Multivariable logistic regression determined predictors of undertriage, controlling for hospital characteristics, injury severity, and comorbidities.

      Results

      Of 4,152,541 emergency department (ED) visits meeting inclusion criteria, 74.0% were treated at lower level TCs or NTCs. Patients at level I and II TCs more commonly had NISS ≥9 (22.2% versus 12.3%, P < 0.001), but among all patients with NISS ≥9, 61.3% were undertriaged to a lower level TC or a NTC. On multivariable logistic regression, factors independently associated with higher odds of being undertriaged were increasing age, female gender, and fall-related injuries. A subgroup analysis examined urban and suburban areas only where access to a TC is more likely and found that 55.8% of patients' age were undertriaged.

      Conclusions

      There is substantial undertriage of patients aged ≥55 y nationwide. Over half of significantly injured older patients are not treated at level I or II TCs. The impact of undertriage should be determined to ensure older patients receive trauma care at the optimal site.

      Keywords

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