Re-triage Moderates Association between State Trauma Funding and Lower Mortality of Trauma Systems

Successful trauma systems coordinate timely triage and care of injured patients from the moment of injury. [1] Regionalization of trauma care has lowered mortality of injured patients by getting the right patients to the right place at the right time. [2], [3], [4], [5], [6], [7], [8], [9], [10], [11] However, field triage remains imperfect, making timely and accurate re-triage an important step in trauma care. Between 29% and 62% of severely injured patients, especially minorities, women, and older adults, are under-triaged in the field and transported to non-trauma and low-level trauma centers. [12], [13], [14], [15], [16] Under-triaged patients experience higher mortality, while those who are rapidly re-triaged from non-trauma and low-level trauma centers to high-level trauma centers experience mortality similar to those taken directly to high-level centers. [17], [18], [19] Yet, 57% to 63% of severely injured, under-triaged patients are never re-triaged. [18,20]

The American College of Surgeons Committee on Trauma (ACSCOT) and the Centers for Disease Control and Prevention (CDC) have established guidelines for field triage. [1,21,22] However, there are currently no national re-triage guidelines. Instead, re-triage and timeliness of re-triage varies widely by state. [23] Differing amounts of state funding for trauma care and systems may contribute to this variation. Funding plays an important role in supporting centers that provide trauma care and infrastructure that ensures that the right patient gets to the right place at the right time. [10,11] We have previously shown that state trauma funding is associated with decreased adjusted in-hospital mortality of injured patients.(Byskosh A, Shi M, Helenowski I, Holl J, Hsia R, Liepert A, et al. Is State Trauma Funding Associated with Mortality Among Injured Hospitalized Patients? Manuscript submitted to Health Services Research.)

This study examines (1) the association between state trauma funding and rates of re-triage, and (2) the role of re-triage as a moderator of the association between state trauma funding and adjusted in-hospital mortality of severely injured patients. We hypothesize that (1) state trauma funding is associated with higher rates of re-triage, and (2) re-triage is a positive moderator of the association between state trauma funding and lower adjusted in-hospital mortality of severely injured patients.

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