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Objective: Unnecessary interfacility transfer of minimally injured patients to a Level I trauma center (secondary overtriage) can cause inefficient use of resources and personnel within a regional trauma system. The purpose of this study was to describe the burden of secondary overtriage in a rural trauma system with a single Level I center.
Design: retrospective analysis of institutional trauma registry data
Setting: Dartmouth Hitchcock Medical Center (DHMC), a rural Level I trauma center
Patients: 7793 injured patients evaluated by the trauma service at DHMC from 1/1/2007-12/31/2011
Interventions: none
Main Outcome Measures: patients transferred from another hospital to DHMC who did not require an operation, had an injury severity score (ISS) < 15, and were discharged alive within 48 hours of admission
Results: 4796 (61.5%) of the 7793 evaluated patients were transferred from other facilities. When compared with scene calls (n=2997), transferred patients had a similar median ISS of 9, but 23.6% of transferred adult patients and 48.8% of transferred pediatric patients met our definition of secondary overtriage. The overtriaged patients were most likely to have injuries of the head and neck (55.85%) followed by skin/soft tissue injuries (40.98%). Seventy-two unique institutions transferred trauma patients to DHMC, but 35.3% of the overtriaged patients were from five institutions.
Conclusions: The incidence of secondary overtriage in our rural trauma center is 26.4%, with head and neck injuries the most common reason for transfer. Costs for transportation and additional evaluation for such a significant percentage of patients has important resource utilization implications. Effective regionalization of rural trauma care should include methods to limit secondary overtriage.