Severely Injured Trauma Patients Are Undertriaged at Nontrauma Centers
WEDNESDAY, Sept. 10, 2025 -- More than half of severely injured trauma patients first treated at level III or nontrauma centers are not transferred to higher-level trauma centers, according to a study published online Aug. 19 in the Journal of the American College of Surgeons.
Jacoby R. Bryce, M.D., from the University of Utah in Salt Lake City, and colleagues used data from the 2019 Nationwide Emergency Department Sample (146,816 adult trauma patients with an Injury Severity Score [ISS] >15) to quantify the volume of severely injured patients who presented to a level III or nontrauma center not transferred to higher-level care.
The researchers found that 58 percent of patients were not transferred, reflecting secondary undertriage. Nontransfer was independently predicted by the patient factors of older age (80 years or older; adjusted odds ratio [aOR], 1.68) and public insurance (Medicare: aOR, 1.76; Medicaid: aOR, 1.44). Level III trauma designation (aOR, 2.93) and metropolitan location (aOR, 5.21) were independent hospital-level predictors. In a subanalysis of patients with an ISS ≥25, these predictors persisted.
"Level III hospitals need to be brought into what we consider to be high-level trauma systems so that we can better support these centers in the trauma care that they do provide and ensure the best possible outcomes for all patients," Marta L. McCrum, M.D., M.P.H., also from the University of Utah, said in a statement.
Disclaimer: Statistical data in medical articles provide general trends and do not pertain to individuals. Individual factors can vary greatly. Always seek personalized medical advice for individual healthcare decisions.
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