Secondary Undertriage of Severely Injured Trauma Patients Across the US

作者：Jacoby R. Bryce, Stephanie E. Iantorno, Jack H Scaife, Meng Yang, Brian T. Bucher, Marta L. McCrum · 发表于：Journal of the American College of Surgeons · 年份：2025 · DOI：10.1097/xcs.0000000000001580 · 被引用次数：4 · 研究领域：Trauma and Emergency Care Studies、Abdominal Trauma and Injuries、Global Health and Surgery

BACKGROUND: Secondary triage is a critical mechanism through which severely injured patients presenting to lower-resource hospitals are transferred to high-resource trauma centers, and is associated with improved survival. We conducted a contemporary, nationally representative analysis to quantify the volume of severely injured patients not transferred to higher-level care and to identify predictors of non-transfer. STUDY DESIGN: Retrospective cohort study using the 2019 Nationwide Emergency Department Sample of all adult trauma patients with an Injury Severity Score (ISS) >15 who first presented to a Level III or non-trauma center (NTC). Primary outcome was non-transfer, defined as admission to the Level III or NTC from the ED. Multivariable generalized linear models were developed to determine patient- and hospital-level predictors of non-transfer. RESULTS: Among 146,816 encounters, 84,695 (58%) patients were not transferred, reflecting secondary undertriage. Independent patient predictors of non-transfer included increasing age (≥80 years aOR 1.68, 95% CI 1.43-1.97) and public insurance (Medicare aOR 1.76 (95% CI 1.54, 2.02), Medicaid aOR 1.44, (95% CI 1.27, 1.65)). Hospital-level predictors included Level III trauma designation (aOR 2.93, 95% CI 2.10, 4.08) and metropolitan location (aOR 5.21, 95% CI 3.43-7.92). These predictors persisted in sub-analysis of patients with ISS ≥ 25. CONCLUSION: 1 in 3 severely injured trauma patients in the US are first treated at level III...