School of Medicine, John A. Burns, Honolulu, HI, USA.
Arizona College of Osteopathic Medicine, Midwestern University, Glendale, Arizona, USA.
Injury. 2024 Feb;55(2):111215. doi: 10.1016/j.injury.2023.111215. Epub 2023 Nov 14.
Over and under-triage represent a misallocation of resources that can affect patient outcomes. The purpose of this study is to evaluate over and under-triage rates in relation to risk factors and associated outcomes of trauma patients nationwide.
A retrospective cohort study using the Trauma Quality Improvement Program from 2017 to 2020. Multivariable regression models were used to assess predictors of over-triage (activation when unnecessary) and under-triage (limited activation when full activation was necessary).
22.2 % (32,782) of the study population were over-triaged and 20.3 % (29,996) were under-triaged. Most over-triaged patients were Black, with Medicaid, or had a penetrating injury, whereas most under-triaged patients were White, with private/commercial insurance, or had a blunt injury. With covariates adjusted for, Pacific Islander (p = 0.024) and American Indian patients (p = 0.015) were associated with higher odds of over-triage, and Hispanic patients had higher odds of under-triage (p<0.001). Patients with Medicare (p<0.001) had higher odds of over-triage, and patients with private/commercial insurance (p<0.001) had higher odds of under-triage compared to Medicaid patients. Patients in level II (p<0.001) and level III (p<0.001) trauma hospitals were associated with higher odds of over-triage.
Pacific Islander and American Indian patients, Medicare, and level II and III trauma centers are at increased risk of over-triage rates, while Hispanic and privately insured trauma patients had a higher risk for under-triage. Future studies should further investigate factors contributing to poor outcomes linked to under-triage practices and methods to improve consistency and standardization of triage tools across various levels of trauma centers.
过分诊和分诊不足都代表了资源的错配，这可能会影响患者的预后。本研究的目的是评估全国范围内创伤患者的分诊过度和不足率及其与危险因素和相关结局的关系。
这是一项使用创伤质量改进计划（2017 年至 2020 年）进行的回顾性队列研究。多变量回归模型用于评估分诊过度（不必要的激活）和分诊不足（需要充分激活时激活不足）的预测因素。
研究人群中 22.2%（32782 人）被过度分诊，20.3%（29996 人）被分诊不足。大多数过度分诊的患者为黑人，有医疗补助保险，或有穿透性损伤，而大多数分诊不足的患者为白人，有私人/商业保险，或有钝性损伤。调整协变量后，与其他种族相比，太平洋岛民（p=0.024）和美洲印第安人（p=0.015）更有可能过度分诊，而西班牙裔患者更有可能分诊不足（p<0.001）。与医疗补助保险患者相比，医疗保险患者（p<0.001）更有可能过度分诊，而私人/商业保险患者（p<0.001）更有可能分诊不足。与医疗补助保险患者相比，医疗保险患者（p<0.001）更有可能过度分诊，而私人/商业保险患者（p<0.001）更有可能分诊不足。与医疗补助保险患者相比，医疗保险患者（p<0.001）更有可能过度分诊，而私人/商业保险患者（p<0.001）更有可能分诊不足。二级（p<0.001）和三级（p<0.001）创伤医院的患者更有可能过度分诊。
太平洋岛民和美洲印第安人、医疗保险以及二级和三级创伤中心的患者过度分诊的风险更高，而西班牙裔和私人保险的创伤患者分诊不足的风险更高。未来的研究应进一步调查导致分诊不足实践相关不良结局的因素，并找到改善各级创伤中心分诊工具一致性和标准化的方法。
