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Invited Commentary
April 2018

Undertriage Remains a Vexing Problem for Even the Most Highly Developed Trauma Systems: The Need for Innovations in Field Triage

Author Affiliations
  • 1Center for Policy and Research in Emergency Medicine, Oregon Health & Science University, Portland
  • 2Center for Surgery and Public Health, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts
  • 3Harvard TH Chan School of Public Health, Boston, Massachusetts
  • 4Deputy Editor, JAMA Surgery
JAMA Surg. 2018;153(4):328. doi:10.1001/jamasurg.2017.4499

Appropriate field triage is key to improving outcomes of trauma patients with severe injuries. Voskens and colleagues1 prospectively analyzed 4950 trauma patients in Central Netherlands, of which 436 (8.8%) had an Injury Severity Score of 16 or more.1 Their findings show an undertriage rate of 21.6% and an overtriage rate of 30.6%, which are similar to what has been demonstrated in other advanced trauma systems, including in the United States.2 The authors report that undertriage varies across age groups, with older adults experiencing a nearly 40% undertriage rate, which is also similar to findings in the United States.3

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