Trauma patients centralization for the mechanism of trauma: old questions without answers

Centralization of trauma patients has become the standard of care. Unfortunately, overtriage can overcome the capability of Trauma Centres. This study aims to analyse the association of different mechanisms of injury with severe or major trauma defined as Injury Severity Score (ISS) greater than 15 and an estimation of overtriage upon our Trauma Centre.

A retrospective review of our prospective database was undertaken from March 2014 to August 2016. Univariate and multivariable logistic regression models were used to estimate the association between covariates (gender, age, and mechanisms of injury) and the risk of major trauma.

The trauma team (TT) treated 1575 patients: among the 1359 (86%) were triaged only because of dynamics or mechanism of trauma. Overtriage according to an ISS < 15, was 74.6% on all trauma team activation (TTA) and 83.2% among the TTA prompted by the mechanism of injury. Patients aged 56–70 years had an 87% higher risk of having a major trauma than younger patients (OR 1.87, 95% CI 1.29–2.71) while for patients aged more than 71 years OR was 3.45, 95% CI 2.31–5.15. Car head-on collision (OR 2.50, 95% CI 1.27–4.92), intentional falls (OR 5.61, 95% CI 2.43–12.97), motorbike crash (OR 1.67, 95% CI 1.06–2.65) and pedestrian impact (OR 2.68, 95% CI 1.51–4.74) were significantly associated with a higher risk of major trauma in a multivariate analysis.

Significant association with major trauma was demonstrated in the multivariate analysis of different mechanisms of trauma in patients triaged only for dynamics. A revision of our field triage protocol with a prospective validation is needed to improve overtriage that is above the suggested limits.