Traumatic Brain Injury Under Triage Risk: A Rural Trauma System Experience


South Atlantic


Grand Strand Medical Center

Document Type


Publication Date



Adult, Humans, Triage, Trauma Centers, Brain Injuries, Traumatic, Injury Severity Score, Anticoagulants, Retrospective Studies, Wounds and Injuries


Nervous System Diseases | Surgery | Trauma


BACKGROUND: The process of interfacility transfer may cause a delay in the necessary medical treatment, which could lead to poor outcomes and increased mortality rates. The ACS-COT considers an acceptable under triage rate of

METHODS: This is a single-center study of Trauma Registry data, from July 1, 2016, to October 31, 2021. The inclusion criteria were based upon age (≥40 years), ICD10 diagnosis of TBI, and interfacility transfer. Under triage using the Cribari matrix method was the dependent variable. A logistic regression was performed to identify additional predictor variables on the likelihood that an adult TBI trauma patient experienced under triage.

RESULTS: 878 patients were included in the analysis; 168 (19%) experienced an under triage. The logistic regression model was statistically significant (N = 837,

CONCLUSIONS: The likelihood of under triage in the adult TBI trauma population is associated with increasing AIS head injuries and increasing ISS and among those with mental health comorbidities. This evidence and additional protective factors, such as patients on anticoagulant therapy, may aid in education and outreach efforts to reduce under triage among the regional referring centers.

Publisher or Conference

The American Surgeon