Are We Caring for Trauma Patients in the Wrong Place? Or in the Wrong Way?

It is well accepted that severely injured patients should be taken to major trauma centers, bypassing closer hospitals, but a visit to a trauma center's emergency department (ED) generally is much more expensive than a visit to a non–trauma center ED. Researchers retrospectively analyzed data for some 300,000 patients transported by 94 emergency medical system agencies in the western U.S. during a 3-year period, to determine which patients were “undertriaged” (brought to a nontrauma hospital with major injuries) and “overtriaged” (brought to a trauma center with minor injuries).

Injury severity was determined from diagnostic codes and was classified as severe in 4% of cases, moderate in 10%, and mild in 86%. The authors reported that 38% of …