A critical analysis of secondary overtriage to a Level i trauma center

Andrew Tang, Ammar Hashmi, Viraj Pandit, Bellal Joseph, Narong Kulvatunyou, Gary Vercruysse, Bardiya Zangbar, Lynn Gries, Terence O'Keeffe, Donald Green, Randall Friese, Peter Rhee

Research output: Contribution to journalArticlepeer-review

44 Scopus citations


Background: Trauma centers often receive transfers from lower-level trauma centers or nontrauma hospitals. The aim of this study was to analyze the incidence and pattern of secondary overtriage to our Level I trauma center.

Methods: We performed a 2-year retrospective analysis of all trauma patients transferred to our Level I trauma center and discharged within 24 hours of admission. Reason for referral, referring specialty, mode of transport, and intervention details were collected. Outcomes measures were incidence of secondary overtriage as well as requirement of major or minor procedure. Major procedure was defined as surgical intervention in the operating room. Minor procedures were defined as procedures performed in the emergency department.

Results: A total of 1,846 patients were transferred to our Level I trauma center, of whom 440 (24%) were discharged within 24 hours of admission. The mean (SD) age was 35 (21) years, 72% were male, and mean (SD) Injury Severity Score (ISS) 4 (4). The most common reasons for referral were extremity fractures (31%), followed by head injury (23%) and soft tissue injuries (13%). Of the 440 patients discharged within 24 hours, 380 (86%) required only observation (268 of 380) or minor procedure (112 of 380). Minor procedures were entirely consisted of fracture management (n = 47, 42%) and wound care (n = 65, 58%). The mean (SD) interfacility transfer distance was 45 (46) miles. Mean (SD) hospital charges per transfer were $12,549 ($5,863).

Conclusion: A significant number of patients transferred to our trauma center were discharged within 24 hours; most of them required observation and/or minor procedures. Appropriately increasing primary hospital resources, in addition to interhospital outreach in the formof education or telemedicine, should be considered to decrease the number of avoidable transfers.

Original languageEnglish (US)
Pages (from-to)969-973
Number of pages5
JournalJournal of Trauma and Acute Care Surgery
Issue number6
StatePublished - Dec 11 2014


  • Minimal injury
  • Overtriage
  • Referrals
  • Transfers
  • Triage

ASJC Scopus subject areas

  • Surgery
  • Critical Care and Intensive Care Medicine


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