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Smith SG, Dewey EN, Eastes LE, Schreiber MA. Efficacy of Prehospital Criteria in Identifying Trauma Patients Susceptible to Undertriage. JAMA Surg. 2019;154(10):973–974. doi:10.1001/jamasurg.2019.2497
Earlier recognition of severe traumatic injury and triage to the proper trauma level designation are essential factors in the safe and effective care of trauma patients.1 Trauma-level activation often dictates the personnel present at the initial trauma resuscitation, and undertriage has been associated with worse clinical outcomes.2
Traditionally, undertriage has been evaluated using the Injury Severity Score. The problem with using this approach to evaluate triage-level appropriateness is that the Injury Severity Score is determined either at the time of discharge or death and therefore cannot prospectively identify patients who were undertriaged.
After a review of 10 years (2004-2014) of data on adult trauma activations at a single institution, tachypnea (respiratory rate, >22 breaths per minute) and blunt thoracic injury were associated with undertriage and were added to higher-level trauma activation criteria at the institution.3 In this study, we sought to determine if other clinically relevant prehospital criteria could be used to accurately identify patients who are more likely to be undertriaged.
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