Undertriage of older trauma patients: is this a national phenomenon?

Background: Older age is associated with high rates of morbidity and mortality after injury. Statewide studies suggest significantly injured patients aged >= 55 y are commonly undertriaged to lower level trauma centers (TCs) or nontrauma centers (NTCs). This study determines whether undertriage is a national phenomenon. Materials and methods: Using the 2011 Nationwide Emergency Department Sample, significantly injured patients aged >= 55 y were identified by diagnosis and new injury severity score (NISS) >= 9. Undertriage was defined as definitive care anywhere other than level I or II TCs. Weighted descriptive analysis compared characteristics of patients by triage status. Multivariable logistic regression determined predictors of undertriage, controlling for hospital characteristics, injury severity, and comorbidities. Results: Of 4,152,541 emergency department (ED) visits meeting inclusion criteria, 74.0% were treated at lower level TCs or NTCs. Patients at level I and II TCs more commonly had NISS >= 9 (22.2% versus 12.3%, P < 0.001), but among all patients with NISS >= 9, 61.3% were undertriaged to a lower level TC or a NTC. On multivariable logistic regression, factors independently associated with higher odds of being undertriaged were increasing age, female gender, and fall-related injuries. A subgroup analysis examined urban and suburban areas only where access to a TC is more likely and found that 55.8% of patients' age were undertriaged. Conclusions: There is substantial undertriage of patients aged >= 55 y nationwide. Over half of significantly injured older patients are not treated at level I or II TCs. The impact of undertriage should be determined to ensure older patients receive trauma care at the optimal site. (C) 2015 Elsevier Inc. All rights reserved.