What question did this study set out to answer?

This study aims to evaluate the effectiveness of Norwegian national trauma criteria in minimizing undertriage and overtriage of patients.

May 29, 2026Open Access

Evaluation of the trauma criteria from the Norwegian national trauma plan: an observational study from a regional trauma centre

Key Points

This study aims to evaluate the effectiveness of Norwegian national trauma criteria in minimizing undertriage and overtriage of patients.
Retrospective cohort study using data from the trauma registry at Haukeland University Hospital from 2017-2021.
Injury Severity Score (ISS) was recorded, and prehospital records were reviewed for trauma criteria adherence.
Analysis focused on the ability of national trauma criteria to predict an ISS > 15 and meet national triage goals.
Out of 2508 analyzed, 384 patients had an ISS > 15, with an overall overtriage rate of 81.1%.
Undertriage was observed in 11.5% of cases, with 44 patients exceeding an ISS > 15 without meeting criteria.
Removing mechanism of injury (MOI) criteria could reduce unnecessary trauma team activations (TTA) by 255 cases in ISS < 15.

Abstract

Abstract Background The national trauma plan defines common Norwegian criteria dictating which patients are met by a trauma team. Precise criteria are important to avoid undertriage and overtriage. Previous studies have indicated that both overtriage and undertriage fail to meet the goals of the Norwegian Trauma Plan, and the aim of the study was to investigate the performance of the new national criteria. Methods This is a retrospective cohort study of patients included in the trauma registry at Haukeland University Hospital between 2017 and 2021. Injury Severity Score (ISS) was extracted from the registry. Prehospital records were manually reviewed to determine which trauma criteria were met. The aim was to analyse how well the national trauma criteria predicted ISS > 15, and if national goals of overtriage and undertriage were met. Results A total of 2508 patients were eligible for analysis, whereas 384 had an ISS > 15, with a total overtriage of 81.1%. Forty-four patients had an ISS > 15 without meeting the criteria, resulting in an undertriage of 11.5%. If hypothetically 4 Patient factors was analysed as an individual criteria group, undertriage would have been 2.9%. Patients who did not meet any criteria had an overtriage of 97.6%. Mechanism of injury (MOI) predicted ISS > 15 in nine of 333 patients, resulting in an overtriage of 97.3% for this criteria group. Hypothetical removal of the MOI criteria except 3.6 Fall would in this data set eliminate 255 Trauma team activations (TTA) among patients with ISS < 15. Conclusions Overtriage was high overall and across all criteria groups. Patients who triggered a TTA despite not meeting any criteria also demonstrated substantial overtriage. To optimize resource use, criteria with low positive predictive value could be assigned fewer resources or revised to reduce unnecessary activations. Our findings support re-evaluation of specific criteria, particularly those related to mechanism of injury.

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