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Undertriage in trauma linked with higher in-hospital mortality
Left behind: Association of prehospital field undertriage and outcomes after injury
Surgery · 2026-09-25 · Added 29 October 2026
A US retrospective cohort of 59,095 injured adults in Pennsylvania found a 53% field undertriage rate, with undertriage associated with a 19% higher relative risk of in-hospital mortality (aRR 1.19) and, for patients over 60, a lower chance of discharge home.
- Study type
- Cohort
- Design
- Retrospective statewide cohort with doubly robust causal modelling
- Participants
- 59,095 injured adults, 2023 Pennsylvania discharge data
- Main finding
- Undertriage rate 53%; adjusted risk ratio for in-hospital mortality 1.19 (95% CI 1.07–1.33); shorter length of stay (-0.29 days); over-60s less likely to be discharged home (aRR 0.95).
- Caveat
- Administrative claims data with ICD-coded criteria for undertriage, which can misclassify both criteria and injury severity.
- Bottom line
- Supports current practice
Why it matters in Australia (High relevance). Triage and destination decisions are core work for Australian crews; the US trauma-system geography differs, but the undertriage question is the same one Australian triage tools try to answer.
Learning goal
Strengthen my judgement on recognising major trauma in older adults to reduce undertriage to major trauma centres.
More
- Topic: Trauma
- Daily scan: 29 October 2026
- Podcast: Paramedic Papers Daily, 29 October 2026
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