Evaluation of Secondary Overtriage at a Rural Level 1 Trauma Center

被引:0
作者
Osher, Jennifer [1 ]
Archer, Allen [1 ]
Heard, Matthew A. [2 ]
McBride, Mary E. [2 ]
Leonard, Matthew [2 ]
Burns, J. Bracken [2 ]
机构
[1] East Tennessee State Univ, Quillen Coll Med, 178 Maple Ave, Johnson City, TN 37684 USA
[2] East Tennessee State Univ, Quillen Coll Med, Dept Surg, Johnson City, TN USA
关键词
trauma acute care; trauma; secondary overtriage; trauma transfer; rural care; TRANSFERS; BENEFIT; CARE;
D O I
10.1177/00031348241262429
中图分类号
R61 [外科手术学];
学科分类号
摘要
Objective To retrospectively assess the prevalence of secondary overtriage (SO) within a rural regional Appalachian health care system.Methods Trauma registry data was extracted for all trauma activation transfer patients from 2017 to 2022. Transferred patients were then stratified into two groups, non-secondary overtriage (non-SO) or SO. Patients were considered SO if they met three criteria following transfer: an Injury Severity Score (ISS) of less than 15, no required operative intervention, and discharge within 48 hours of arrival. Descriptive statistics were compared for age, length of stay (LOS), ICU LOS, and ISS. Surgical subspecialty consultations were compared between the two groups. Patients in the SO group were further assessed by body region of injury and Abbreviated Injury Score (AIS).Results Among 3,291 trauma activation transfer patients, 43% (1,407) were considered SO transfers. Patients in the SO group were significantly younger, had shorter average hospital and ICU LOS, and lower ISS compared to the non-SO group. Additionally, 25.7% of patients in the SO group had injuries to the head or neck of which 8.96% have an AIS >= 3. 21% of patients had injuries to the face, with 0.14% having an AIS >= 3.Conclusions 43% of transfer patients in this study met our definition of SO. Although no optimal rate of SO has been universally established, limiting SO stands to benefit both patients and trauma systems. This study highlights how institutional analysis of transfer patients may help inform transfer protocols to reduce secondary overtriage and overutilization of scarce resources.
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页码:2244 / 2248
页数:5
相关论文
共 13 条
[1]  
Bukur M, 2018, AM SURGEON, V84, P1368
[2]   Disparities in access to trauma care in the United States: A population-based analysis [J].
Carr, Brendan G. ;
Bowman, Ariel J. ;
Wolff, Catherine S. ;
Mullen, Michael T. ;
Holena, Daniel N. ;
Branas, Charles C. ;
Wiebe, Douglas J. .
INJURY-INTERNATIONAL JOURNAL OF THE CARE OF THE INJURED, 2017, 48 (02) :332-338
[3]  
Chreiman KM., 2022, MANAGEMENT CHEST TRA, P1, DOI [10.1007/978-3-031-06959-81, DOI 10.1007/978-3-031-06959-81]
[4]   Secondary overtriage: A consequence of an immature trauma system [J].
Ciesla, David J. ;
Sava, Jack A. ;
Street, James H., III ;
Jordan, Marion H. .
JOURNAL OF THE AMERICAN COLLEGE OF SURGEONS, 2008, 206 (01) :131-137
[5]   Secondary overtriage in a statewide rural trauma system [J].
Con, Jorge ;
Long, Dustin ;
Sasala, Emily ;
Khan, Uzer ;
Knight, Jennifer ;
Schaefer, Greg ;
Wilson, Alison .
JOURNAL OF SURGICAL RESEARCH, 2015, 198 (02) :462-467
[6]   Futile trauma transfers: An infrequent but costly component of regionalized trauma care [J].
Follette, Craig ;
Halimeh, Bachar ;
Chaparro, Annelise ;
Shi, Alan ;
Winfield, Robert .
JOURNAL OF TRAUMA AND ACUTE CARE SURGERY, 2021, 91 (01) :72-76
[7]   Survival Benefit of Transfer to Tertiary Trauma Centers for Major Trauma Patients Initially Presenting to Nontertiary Trauma Centers [J].
Garwe, Tabitha ;
Cowan, Linda D. ;
Neas, Barbara ;
Cathey, Timothy ;
Danford, Brandon C. ;
Greenawalt, Patrice .
ACADEMIC EMERGENCY MEDICINE, 2010, 17 (11) :1223-1232
[8]   Resource utilization and secondary overtriage for patients with traumatic renal injuries in a regional trauma system [J].
Iyer, Vishnu ;
Hagedorn, Judith C. ;
Vavilala, Monica S. ;
Rivara, Frederick P. ;
Johnsen, Niels, V .
JOURNAL OF TRAUMA AND ACUTE CARE SURGERY, 2022, 92 (06) :1061-1065
[9]   The benefit of higher level of care transfer of injured patients from nontertiary hospital emergency departments [J].
Newgard, Craig D. ;
McConnell, K. John ;
Hedges, Jerris R. ;
Mullins, Richard J. .
JOURNAL OF TRAUMA-INJURY INFECTION AND CRITICAL CARE, 2007, 63 (05) :965-971
[10]   Rapid Discharge After Transfer: Risk Factors, Incidence, and Implications for Trauma Systems [J].
Osen, Hayley B. ;
Bass, Robert R. ;
Abdullah, Fizan ;
Chang, David C. .
JOURNAL OF TRAUMA-INJURY INFECTION AND CRITICAL CARE, 2010, 69 (03) :602-606