Secondary Undertriage in a Rural Trauma System: A Retrospective Study of Twice-Transferred Patients

Isaac Slagel; Colette Galet; James Torner; Ashleigh Bull; Kristen Sihler

doi:10.1016/j.jss.2025.03.003

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Secondary Undertriage in a Rural Trauma System: A Retrospective Study of Twice-Transferred Patients

Journal article

Peer reviewed

Secondary Undertriage in a Rural Trauma System: A Retrospective Study of Twice-Transferred Patients

Isaac Slagel, Colette Galet, James Torner, Ashleigh Bull and Kristen Sihler

The Journal of surgical research, Vol.309, pp.103-110

05/2025

DOI: 10.1016/j.jss.2025.03.003

PMCID: PMC12124943

PMID: 40250020

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Abstract

Undertriage is a metric of trauma system efficiency. In rural areas, field undertriage is a necessity due to long distances to other trauma centers. We investigated multiple transferred trauma patients from 2017 to 2020 to better understand secondary trauma triaging in a rural trauma system. This was a retrospective cohort study. One hundred trauma patients were transferred multiple times before arrival to our level I trauma center between 2017 and 2020. Data were collected from our institution's trauma registry and medical records. Results were compared to a previous study from 1996 to 1999. Eighty-seven eligible patients, 70 (80.5%) adults and 17 (19.5%) pediatric patients, were included. In comparison to 1996-1999, fewer trauma patients were twice transferred controlled for total trauma volume (3.0% versus 0.66%, P < 0.05). Patients were older (37.5 versus 47.1 years, P < 0.05) and less likely to be male compared to the original study (78.0 versus 62.1%, P < 0.05). Nearly 90% of adults first presented to state-verified level 4 trauma centers. Of those, 90.3% were transferred to a higher-level facility (Level 1: 14, Level 2: 14, and Level 3: 28). Over the past 2 decades, the rate of secondary undertriage as measured by twice transferred trauma patients has declined significantly in our state. Further studies are warranted to understand the impact of multiple transfers on patient outcomes.

Multiple transfer

Rural

Trauma system

Undertriage

Details

Title: Subtitle: Secondary Undertriage in a Rural Trauma System: A Retrospective Study of Twice-Transferred Patients
Creators: Isaac Slagel - Carver College of Medicine
Colette Galet - Acute Care Surgery Division, Department of Surgery
James Torner - University of Iowa
Ashleigh Bull - Acute Care Surgery Division, Department of Surgery
Kristen Sihler - Acute Care Surgery Division, Department of Surgery
Resource Type: Journal article
Publication Details: The Journal of surgical research, Vol.309, pp.103-110
DOI: 10.1016/j.jss.2025.03.003
PMID: 40250020
PMCID: PMC12124943
NLM abbreviation: J Surg Res
ISSN: 0022-4804
eISSN: 1095-8673
Publisher: Elsevier Inc
Grant note: National Heart, Lung, and Blood Institute of the National Institutes of Health: T35HL166206
Research reported in this publication was partially supported by the National Heart, Lung, and Blood Institute of the National Institutes of Health under Award Number T35HL166206.
Language: English
Electronic publication date: 04/17/2025
Date published: 05/2025
Academic Unit: Neurology; Epidemiology; Surgery; Injury Prevention Research Center; Neurosurgery
Record Identifier: 9984810946002771

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