The potential impact of changing the Norwegian trauma Registry inclusion criteria for patients not admitted with trauma team activation: Identifying patient groups to be excluded and considering potential risks

One of the inclusion criteria of the Norwegian Trauma Registry (NTR) is a New Injury Severity Score (NISS) > 12 for patients not admitted with trauma team activation (TTA). Based on registry data and clinical experience, patients with NISS of 13 or 14 who are not admitted with TTA often have low-energy falls as the primary injury mechanism. Identifying and registering these patients requires considerable effort. However, it is unknown what effects exclusion of patients with a NISS of 13 or 14 not admitted with TTA will have on the risk and safety of this group of trauma patients. Registry data from a cohort of patients admitted to Norwegian trauma hospitals during 2017–2021 with NISS 13 or 14 who were not met with TTA (group 1) were compared to a cohort of patients with the same NISS scores met with TTA (group 2), and the total registry population, respectively (group 3). Group 1 (n = 815) consisted mainly of elderly females (58%), with low-energy falls (73%). The group had a significantly higher proportion of injuries in the lower extremity (61%) and underwent fewer medical interventions than the two comparison groups. Increasing the criteria would result in the exclusion of a patient group mainly consisting of elderly women injured with low-energy trauma and hence it is out of the primary scope of a national trauma registry. Uncertainty exists regarding the male patients, who exhibit a higher proportion of injury mechanisms that may have warranted TTA.