Overtriage in a Norwegian trauma population: a national register-based study

Abstract

Background: Several previous studies have shown that a large number of trauma patients in Norway are overtriaged. Overtriage in trauma is commonly defined as patients who have been met by trauma team, but where physical and radiological examination reveals that they only have minor injuries. Minor injuries are defined as an Injury Severity Score (ISS) lower than 15. An overtriage rate between 2535% is considered acceptable in order to avoid undertriage. Undertriage is conversely defined as those with severe injury (ISS > 15), who are not met by a trauma team. Aim: This study aims to investigate overtriage rate in a Norwegian trauma population and to describe the characteristics of those who are overtriaged and the level of hospital resources utilized. Methods: The study is a retrospective registry study. Data from National Trauma Registry (NTR) from 01.01.2017 to 31.12.2020 was collected and analyzed to identify the rate of overtriage and describe the resource utilized. Results: Data from 30,618 patients was included. The analysis showed a national overtriage rate of 88.4% with patients Injury Severity Score (ISS) < 15. The male proportion was 67.5% and the median age was 36 years. The median ISS was 2. The overtriage rate of the hospitals ranged between varied 81.1% to 96.2%, and 25 of the 38 hospitals had an overtriage rate of more than 90%. Fourteen hospitals had less than ten severely injured patients on an annual basis. The majority of patients (71.5%) were transported to acute care hospitals and 28.5% were transported to a trauma center. Conclusion: The overtriage rate of the Norwegian trauma population is substantial, and there is considerable variation between hospitals. Therefore, targeted interventional measures to reduce the overuse of hospital resources seems warranted and should be addressed when revising new trauma team activation guidelines.