Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2018 Aug 14;26(1):64.
doi: 10.1186/s13049-018-0524-z.

Undertriage of major trauma patients at a university hospital: a retrospective cohort study

Terje Nordgarden  1 , Peter Odland  2 , Anne Berit Guttormsen  3   4 , Kristina Stølen Ugelvik  5
Affiliations

Undertriage of major trauma patients at a university hospital: a retrospective cohort study

Terje Nordgarden et al. Scand J Trauma Resusc Emerg Med. .

Abstract

Background: Studies show increased mortality among severely injured patients not met by trauma team. Proper triage is important to ensure that all severely injured patients receive vital trauma care. In 2017 a new national trauma plan was implemented in Norway, which recommended the use of a modified version of "Guidelines for Field Triage of Injured Patients" to identify severely injured patients.

Methods: A retrospective study of 30,444 patients admitted to Haukeland University Hospital in 2013, with ICD-10 injury codes upon discharge. The exclusion criteria were department affiliation considered irrelevant when identifying trauma, patients with injuries that resulted in Injury Severity Score < 15, patients that did receive trauma team, and patients admitted > 24 h after time of injury. Information from patient records of every severely injured patient admitted in 2013 was obtained in order to investigate the sensitivity of the new guidelines.

Results: Trauma team activation was performed in 369 admissions and 85 patients were identified as major trauma. Ten severely injured patients did not receive trauma team resuscitation, resulting in an undertriage of 10.5%. Nine out of ten patients were men, median age 54 years. Five patients were 60 years or older. All of the undertriaged patients experienced fall from low height (< 4 m). Traumatic brain injury was seen in six patients. Six patients had a Glasgow Coma Scale score ≤ 13. The new trauma activation guidelines had a sensitivity of 95.0% in our 2013 trauma population. The degree of undertriage could have been reduced to 4.0% had the guidelines been implemented and correctly applied.

Conclusions: The rate of undertriage at Haukeland University Hospital in 2013 was above the recommendations of less than 5%. Use of the new trauma guidelines showed increased triage precision in the present trauma population.

Keywords: American College of Surgeons, Committee on trauma; Guidelines for Field Triage of Injured Patients; Haukeland University Hospital; National Trauma Plan; Norway; Trauma; Trauma team; Undertriage.

PubMed Disclaimer

Conflict of interest statement

Ethics approval and consent to participate

Not applicable.

Consent for publication

Not applicable.

Competing interests

The authors declare that they have no competing interests.

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Figures

Fig. 1
Fig. 1
Trauma team activation criteria
Fig. 2
Fig. 2
Transport criteria
Fig. 3
Fig. 3
Methods
See this image and copyright information in PMC

Similar articles

See all similar articles

Cited by

See all "Cited by" articles

References

    1. Mullins RJ, et al. Outcome of hospitalized injured patients after institution of a trauma system in an urban area. Jama. 1994;271(24):1919–24. doi: 10.1001/jama.1994.03510480043032. - DOI - PubMed
    1. Mullins RJ, et al. Influence of a statewide trauma system on location of hospitalization and outcome of injured patients. J Trauma. 1996;40(4):536–545. doi: 10.1097/00005373-199604000-00004. - DOI - PubMed
    1. Mullins RJ, et al. Preferential benefit of implementation of a statewide trauma system in one of two adjacent states. J Trauma. 1998;44(4):609–616. doi: 10.1097/00005373-199804000-00009. - DOI - PubMed
    1. McDermott FT, Cordner SM. Victoria's trauma care system: national implications for quality improvement. Med J Aust. 2008;189(10):540–542. - PubMed
    1. Gerardo CJ, et al. The rapid impact on mortality rates of a dedicated care team including trauma and emergency physicians at an academic medical center. J Emerg Med. 2011;40(5):586–591. doi: 10.1016/j.jemermed.2009.08.056. - DOI - PubMed

LinkOut - more resources