72103 - Undertriage of severely injured patients at one non-trauma center hospital in Stockholm

Abstract Introduction In a regional trauma system where all severely injured patients are transported to a designated trauma center hospital, trauma triage at non-trauma center hospitals may face additional challenges as patients are assumed to not be severely injured. No recent studies have examined triage accuracy in relation to current guidelines at non-trauma center hospitals the regional trauma system in Stockholm. Method Trauma patients treated at Södersjukhuset during 2019-2022 were identified using the Swedish Trauma Registry. Undertriage was defined in accordance with national guidelines as the proportion of patients with NISS ≥16 who did not prompt level 1 trauma team activation (TTA) on arrival to hospital. Triage charts were reviewed to determine whether any TTA criteria were met at the time of arrival. Post-hoc injury severity was not available when evaluating triage charts. Result A total of 849 severely injured patients presented to the emergency department during the study period; the rate of level 1 TTA in this cohort was 2.2% (n=19), corresponding to an undertriage of 98% as defined by Swedish national guidelines. Of these patients, 21% (n=188) met at least one of the specified level 1 TTA criteria. The rate of level 2 TTA for severely injured patients was 41% (n=348); the remaining 57% (n=482) prompted no TTA on arrival to the emergency department. Discussion In this setting, trauma triage was highly inaccurate; the majority of severely injured patients prompted no TTA on arrival. The specified TTA criteria may be unsuitable for identification of severely injured patients at non-trauma center hospitals.