Associations of undertriage on trauma care processes and mortality across age groups

Abstract Introduction Early identification of life-threatening injuries is crucial for reducing morbidity and mortality. Undertriage of trauma patients, more common among older individuals, is associated with an elevated risk of missed injuries and necessary interventions. This study aimed to investigate associations between undertriage, trauma care processes and mortality, overall and across age groups. Method Data were retrieved from the Swedish National Trauma Registry (2018-2021) and included demographic data, trauma care processes (such as time to computed tomography, emergency interventions, and ICU-admission), and 30-day mortality. Undertriage was defined as a New Injury Severity Score (NISS) above 15 without trauma team activation. Patients were categorized into the following age strata: <65, 65-74, 75-84, and ≥85 years. Result We included 31,870 trauma patients. Of the 9916 severely injured patients with NISS>15, 3068 (31%) were undertriaged. Undertriaged patients had fewer intubations, ICU-admissions, and overall lower mortality <65 years (3% vs. 12%), 65-74 years (10% vs. 16%), 75-84 years (42% vs. 54%) and ≥85 (31% vs. 51%). With increasing age, emergency interventions decreased while mortality significantly increased, especially in patients ≥85 years. Discussion Fewer trauma care processes combined with low mortality rates in undertriaged patients, demonstrate that undertriage was not associated with a poor outcome in the current study. With increasing age, the number of emergency interventions decreased while mortality significantly increased especially in patients aged 85 years and older. This was likely due to the high prevalence of low-energy injuries, which seldom require emergency interventions, and severe comorbidities in the older trauma population.