• Robin D Lokerman, Job F Waalwijk, Rogier van der Sluijs, Roderick M Houwert, LeenenLuke P HLPHDepartment of Surgery, University Medical Center Utrecht, Utrecht, The Netherlands; Trauma Center Utrecht, Utrecht, The Netherlands., Mark van Heijl, and Pre-hospital Trauma Triage Research Collaborative (PTTRC).
• Department of Surgery, University Medical Center Utrecht, Utrecht, The Netherlands. Electronic address: rdlokerman@gmail.com.
• Injury. 2022 May 1; 53 (5): 1699-1706.

IntroductionEvaluating pre-hospital triage and decision-making in patients who died post-trauma is crucial to decrease undertriage and improve future patients' chances of survival. A study that has adequately investigated this is currently lacking. The aim of this study was therefore to evaluate pre-hospital triage and decision-making in patients who died within 30 days post-trauma.Materials And MethodsA multi-site, multi-center, cohort study was conducted. Trauma patients who were transported from the scene of injury to a trauma center by ambulance and died within 30 days post-trauma, were included. The main outcome was undertriage, defined as erroneously transporting a severely injured patient (Injury Severity Score ≥ 16) to a lower-level trauma center.ResultsBetween January 2015 and December 2017, 2116 patients were included, of whom 765 (36.2%) were severely injured. A total of 103 of these patients (13.5%) were undertriaged. Undertriaged patients were often elderly with a severe head and/or thoracic injury as a result of a minor fall (< 2 m). A majority of the undertriaged patients were triaged without assistance of a specialized physician (100 [97.1%]), did not meet field triage criteria for level-I trauma care (81 [78.6%]), and could have been transported to the nearest level-I trauma center within 45 min (93 [90.3%]).ConclusionApproximately 14% of the severely injured patients who died within 30 days were undertriaged and could have benefited from treatment at a level-I trauma center (i.e., specialized trauma care). Improvement of pre-hospital triage is needed to potentially increase future patients' chances of survival.Copyright © 2022. Published by Elsevier Ltd.

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