A Comprehensive Analysis of Undertriage in a Mature Trauma System Using Geospatial Mapping.

Introduction The correct triage of trauma patients to trauma centers (TCs) is essential. We sought to determine the percentage of patients who were undertriaged (UTR) within the Pennsylvania (PA) trauma system and spatially analyze areas of UTR in PA for all age groups: pediatric, adult and geriatric. We hypothesized that there would be certain areas that had high UTR for all age groups. Methods From 2003-2015, all admissions from the Pennsylvania Trauma Systems Foundation (PTSF) registry and those meeting trauma criteria (ICD-9: 800-959) from the Pennsylvania Health Care Cost Containment Council (PHC4) database were included. Admissions were divided into age groups: pediatric ( 9 were included in adult and geriatric age groups. UTR was defined as patients not admitted to Level I/II adult TCs (n=24), pediatric (n=3) or adult and pediatric combined facility (n=3) divided by the total number of patients from the PHC4 database. ArcGIS Desktop and GeoDa were used for geospatial mapping of UTR with a spatial empirical Bayesian smoothed UTR by Zip Code Tabulation Area (ZCTA) and Stata for statistical analyses. Results There were significant percentages of UTR for all age groups. One area of high UTR for all age groups had TCs and large non-trauma centers (NTCs) in close proximity. There were high rates of undertriage for all ages in rural areas, specifically in the upper central regions of PA, with limited access to TCs. Conclusion It appears there are two patterns leading to undertriage. The first is in areas where TCs are in close proximity to large competing NTCs which may lead to inappropriate triage. The second has to do with lack of access to TCs. Geospatial mapping is a valuable tool that can be used to ascertain where trauma systems should focus scarce resources to decrease UTR. Level of evidence Epidemiological; Level III.