J. Talarek1, J. Wycech Knight1,2, I. Puente1,2,3,4, A.A. Fokin2,4 1Broward Health Medical Center, Trauma Services, Fort Lauderdale, FL, USA 2Delray Medical Center, Trauma Services, Delray Beach, FL, USA 3Florida International University, Herbert Wertheim College Of Medicine, Miami, FL, USA 4Florida Atlantic University, Charles E Schmidt College Of Medicine, Boca Raton, FL, USA
Introduction: Previous studies have shown higher undertriage rates in geriatric patients. Some patients who are initially transported to a non-trauma center (NTC) require transfer to a trauma center (TC) for a higher level of care. Secondary overtriage (SOT) refers to the inter-facility transfer of minimally injured trauma patients to TC and is associated with a rapid discharge from the receiving hospital and a lack of surgical interventions. SOT provides no clinical benefit, strains TC resources and is costly for patients. The aim was to compare the rates of SOT in geriatric and non-geriatric patients using different SOT definitions.
Methods: This IRB approved study included trauma patients who were transferred from NTC to an urban level 1 TC over 3,5 years. Two groups were compared: 1,249 geriatric patients (≥65 years old) and 807 non-geriatric patients (18-64 years old). Analyzed variables included mechanism of injury (MOI), Injury Severity Score (ISS), Glasgow Coma Scale (GCS), transfer reason, transfer time, surgery rate, intensive care unit (ICU) admissions, hospital lengths of stay (HLOS) and mortality. Different variables in the definition of SOT included surgical interventions, ICU admissions, mortality, HLOS <24 hours, HLOS <48 hours, ISS <16.
Results: Geriatric patients constituted the majority (60.7%) of TC transfer patients, which is in line with the TC location. The primary MOI was falls in both groups, but they were more common in geriatric patients (89.9% vs 42.9%). Head injuries were the primary reason for transfer in both groups (66.5% and 44.6%) and GCS was comparable (14.2 vs 14.3). Geriatric patients had higher ISS (12.4 vs 10.5, p<0.001; median: 10.0 vs 9.0), more patients with ISS≥16 (34.6% vs 23.9%, p<0.001) and were transferred quicker (4.0 vs 4.4 hours, p=0.03) than non-geriatric patients. Geriatric patients had lower surgery rates (14.5% vs 24.8%, p<0.001), more blood product transfusions (27.5% vs 13.3%, p<0.001), higher ICU admissions (50.4% vs 39.0%, p<0.001), higher mortality (10.5% vs 2.2%, p<0.001), and shorter HLOS (4.2 vs 5.3 days, p=0.04). Figure 1 depicts the analyzed different definitions of SOT. SOT rates ranged from 11.8% to 39.8% and were always higher in non-geriatric patients. The lowest difference in SOT rates between the groups was when the definition included HLOS<24 hours, no ICU admission, no surgical interventions and no mortality. While the highest difference was when the definition included ISS<16, HLOS<48 hours and no ICU admission.
Conclusion: SOT rates were always higher in non-geriatric patients potentially suggesting an increased care and overutilization of resources in non-geriatric trauma patients compared to geriatric patients.