Undertriage of older trauma patients: is this a national phenomenon?

J Surg Res. 2015 Nov;199(1):220-9. doi: 10.1016/j.jss.2015.05.017. Epub 2015 May 18.


Background: Older age is associated with high rates of morbidity and mortality after injury. Statewide studies suggest significantly injured patients aged ≥55 y are commonly undertriaged to lower level trauma centers (TCs) or nontrauma centers (NTCs). This study determines whether undertriage is a national phenomenon.

Materials and methods: Using the 2011 Nationwide Emergency Department Sample, significantly injured patients aged ≥55 y were identified by diagnosis and new injury severity score (NISS) ≥9. Undertriage was defined as definitive care anywhere other than level I or II TCs. Weighted descriptive analysis compared characteristics of patients by triage status. Multivariable logistic regression determined predictors of undertriage, controlling for hospital characteristics, injury severity, and comorbidities.

Results: Of 4,152,541 emergency department (ED) visits meeting inclusion criteria, 74.0% were treated at lower level TCs or NTCs. Patients at level I and II TCs more commonly had NISS ≥9 (22.2% versus 12.3%, P < 0.001), but among all patients with NISS ≥9, 61.3% were undertriaged to a lower level TC or a NTC. On multivariable logistic regression, factors independently associated with higher odds of being undertriaged were increasing age, female gender, and fall-related injuries. A subgroup analysis examined urban and suburban areas only where access to a TC is more likely and found that 55.8% of patients' age were undertriaged.

Conclusions: There is substantial undertriage of patients aged ≥55 y nationwide. Over half of significantly injured older patients are not treated at level I or II TCs. The impact of undertriage should be determined to ensure older patients receive trauma care at the optimal site.

Keywords: Geriatric trauma; Nationwide Emergency Department Sample; Trauma centers; Trauma triage.

MeSH terms

  • Age Factors
  • Aged
  • Aged, 80 and over
  • Emergency Service, Hospital / statistics & numerical data
  • Female
  • Healthcare Disparities / statistics & numerical data*
  • Humans
  • Injury Severity Score
  • Logistic Models
  • Male
  • Middle Aged
  • Socioeconomic Factors
  • Trauma Centers / statistics & numerical data
  • Triage / statistics & numerical data*
  • United States
  • Wounds and Injuries / diagnosis*