Secondary overtriage of trauma patients in a trauma center: frequency and associated factors

Abstract

Abstract: Background: Secondary overtriage (SO) is the unnecessary transfer of traumatic patients between facilities, which causes the waste of the resources of the trauma centers and imposes extra costs on patients and caregivers. This study aimed to determine the frequency of secondary overtriage and patient-level, clinical, and hospital factors leading to secondary overtriage. Methods: This cross-sectional study evaluated the data of all trauma patients who were transferred to a high-level trauma center in Guilan between 2016 and 2020. The patients with SO were characterized as those transported to a trauma center with an injury severity score ≤15 and discharged alive within 48 hours without undergoing surgical procedure. Secondary overtriage and appropriate transmissions were analyzed using descriptive statistics. Multivariate logistic regression was used to identify the relationship between SO and patient-level, clinical, and hospital factors. Results: Out of 3342 transferred trauma patients, 3091(92.49%) had the inclusion criteria. The rate of SO was 25.68 % (794). These patients were younger (median 34 versus 36), with 253 women and 541 men. The highest SO belonged to spine injuries (109, 38.2%) (P less than 0.05). In both secondary overtriaged and appropriately triaged patients, the main cause of transmission was the shortage of neurosurgeons (741, 93.3% and 1780, 77.5%) (P less than 0.05). At the patient level, sex (OR 0.632, 95%CI 0.480-0.832) and at the clinical level, injured body region (specifically spine injury (OR 2.233, 95%CI 1.472-3.388), the reason for transfer (OR 2.158, 95%CI 1.185-3.927), injury severity score (OR 0.655, 95%CI 0.0615-0.697) and length of stay (OR 0.368, 95%CI 0.317-0.428) had a significant relationship with secondary overtriage. Conclusions: About a quarter of transferred traumatic patients were identified as secondary overtriage. Continuous medical education, recruiting trained staff, improving the transfer protocols, extending collaborations between low-level/non-trauma and high-level trauma centers and using telemedicine can provide medical staff with more efficient guidance on transfer decision.