THE TRAUMA ACTIVATION REVIEW COMMITTEE: RESPONSE TO UNDERTRIAGE DURING A PERIOD OF RAPID GROWTH AT A LEVEL II TRAUMA CENTER

Objectives: Trauma triage criteria is constantly being refined for improved identification of critically ill patients at risk for deterioration. Adjustments made to trauma triage criteria can decrease errors in triage events. Tracking these changes over time can minimize events leading to over and under triaging trauma patients.

Methods: Two time periods of trauma registry data at a single rural Level 2 trauma center were reviewed retrospectively and compared with each other to evaluate demographics, injury severity scores, and outcome data, to evaluate for triage errors. The latter period’s trauma activation criteria was adjusted based on the growing population and expansion of the community by a review committee.

Results: There were 300 activated trauma patients in 2011 and 1035 activated patients in 2019. Overtriage rates in 2011 were 23% and 20.5% in 2019. Undertriage rates were 3.7% in 2011 and 2.2% in 2019. Mortality decreased over time overall. Trauma I patients for both years were overall younger, had a higher ISS, and stayed in the hospital and ICU longer. When compared to 2011, Trauma I patients in 2019 were older and spent more days on the ventilator and in the ICU (all p < 0.001). Trauma II patients in 2019 were also older, had lower ISS and number of hospital days, but longer number of days on the ventilator and in the ICU (all p < 0.001).

Conclusion: Using evaluations of overtriage and undertriage to provide feedback to the providers and staff making pre-hospital or ER triage decisions can further refine triage choices and improve patient outcomes even while a trauma center is experiencing a period of rapid growth.