Parikh PP, et al. - Researchers performed the first study assessing if regionalization of trauma care, including the distribution of trauma centers, is associated with secondary overtriage (SO). This retrospective cohort study of statewide data indicates a 12.2% rate of secondary overtriage. The rate of secondary overtriage significantly increases in correlation with system-level factors, such as trauma center distribution and choice of destination by emergency medical services professionals. Findings emphasize the significance of optimizing the number and location of trauma centers based on incidence rates of trauma. Reduction in SO could be achieved via developing better guidelines for patient transfer, and better training and education outreach to the emergency department physicians, along with the use of telemedicine.

Methods

• Researchers used 2008-2012 data from the Ohio Trauma and Emergency Medical Services registries to perform this retrospective cohort study.
• They included all patients taken to level III or nontrauma centers from the scene of the injury with an Injury Severity Score less than 15 and discharged alive.
• Among these, patients who were subsequently transferred to a level I or II trauma center, had no surgical intervention, and were discharged alive within 48 hours of admission, were identified as having SO.
• System-level factors associated with SO were identified using multiple logistic regression.
• From August 1, 2017 to January 31, 2018, they performed statistical analysis.
• The occurrence of SO was assessed as the primary outcome.

Results

• In the 2 registries, 34,494 trauma patients could be matched.
• Among these, inclusion criteria was met by 7,881 (22.9%) patients, of whom 965 (12.2%) had SO.
• The SO group had the median age of 40 years (interquartile range, 26-55 years), with 299 women and 666 men.
• Findings revealed a significant association of system-level factors (number of level I or II trauma centers in the region [>1]) with SO after adjusting for age, sex, comorbidities, injury type, and insurance status (adjusted odds ratio, 1.98; 95% CI, 1.64-2.38; P < .001; area under the curve, 0.89).
• The likelihood of SO was significantly enhanced in relation to the reasons for choice of destination by emergency medical services (specifically, choosing the closest facility: adjusted odds ratio, 1.65; 95% CI, 1.37-1.98; P < .001) and use of a field trauma triage protocol (adjusted odds ratio, 2.21; 95% CI, 1.70-2.87; P < .001).