Injury Severity Score Precision for Determining Undertriage in Trauma Consultation Patients: A Retrospective Study

Objectives Because the Injury Severity Score (ISS) has not been fully endorsed for determining trauma undertriage, we investigated its precision. This study aimed to 1) compute undertriage proportions using the Peng and Cribari methods; 2) compare risk conditions and outcomes for patients with ISS ≥16 who were classified according to an activation or consultation status; 3) calculate proportions of patients with ISS ≥16, without and with qualifications (death or increased length of stay), as potential categories for assessing undertriage in trauma consultation patients; and 4) compute the undertriage proportion among trauma consultation patients by using an intracranial hemorrhage (ICH)-Glasgow Coma Scale score (GCS)-ISS categorization method and employing targeted electronic medical record audits (EMRA). Methodology Age, ISS, GCS, activation status (full, partial, or consultation), injury mechanism, death, intensive care stay, and hospital stay were obtained from the trauma registry. An adverse outcome (AO) was death, intensive care stay ≥two days, or hospital stay >five days. ICH status, clinical details, and comorbidity were obtained from EMRA. Each consultation patient was assigned to an ICH-GCS-ISS category with targeted EMRA. Results Of 2,076 consecutive trauma center admissions, 405 had full activation, 640 had partial activation, and 1,031 had consultation. Using Peng and Cribari methods, undertriage proportions were 64.2% and 21.7%, respectively. Compared with consultation patients with ISS ≥16, full or partial activation patients with ISS ≥16 had much higher proportions (p