Parikh PP, et al. - Researchers investigated the impact of regionalization of trauma care, including the distribution of trauma centers, on secondary overtriage (SO). They also assessed clinical and demographic factors that may lead to SO. They identified a 12.2% rate of SO, in which SO was noted to be significantly associated with the distribution of major trauma centers in the region. These findings highlighted the significance of identifying the optimal number and distribution of trauma centers. Specific outreach and collaboration of level III trauma centers and non-trauma centers with level I and II trauma centers, along with the use of telemedicine, may provide further guidance to level III trauma centers and non-trauma centers on the timing of transfer for injured patients.

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 non-trauma centers from the scene of the injury with an Injury Severity Score < 15 and discharged alive.
• Among these patients, those 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 patients with SO.
• Descriptive analysis was performed of the SO group.
• Using multiple logistic regression, they determined system-level factors associated with SO.
• They performed statistical analysis from August 1, 2017, to January 31, 2018.
• Occurrence of SO was the primary assessment.

Results

• Researchers identified 34,494 trauma patients who could be matched in the 2 registries; among these, inclusion criteria were met by 7,881 (22.9%).
• SO was noted for 12.2% patients.
• The SO group had median age of 40 years (interquartile range, 26-55 years), with 299 women and 666 men.
• System-level factors (number of level I or II trauma centers in the region [> 1]) were noted to be significantly associated 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 < 0.001; area under the curve, 0.89).
• The likelihood of SO was significantly increased in correlation 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 < 0.001) and use of a field trauma triage protocol (adjusted odds ratio, 2.21; 95% CI, 1.70-2.87; P < 0.001).