Observational studyPloS one2019
Defining the representativeness heuristic in trauma triage: A retrospective observational cohort study.
Observational study in PloS one, 2019. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 8 papers.
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The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
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Who cites it
8 citing papers in PubMed.
- Inside the Black Box of Deliberate Practice: How do Coaches Coach to Improve Trauma Triage.The Journal of surgical research · 2024Trial
- Teaching common cognitive biases and associated errors in veterinary neurologic diagnosis using clinical vignettes: a narrative review.Frontiers in veterinary science · 2026Review
- Comparative Evaluation of Machine Learning and Specialist Physicians in Breast Care Triaging: A Real-World Observational Study.European journal of breast health · 2025Article
- Recovery Potential in Patients After Cardiac Arrest Who Die After Limitations or Withdrawal of Life Support.JAMA network open · 2025Article
- Costs of Transfer From Nontrauma to Trauma Centers Among Patients With Minor Injuries.JAMA network open · 2024Article
- Testing the feasibility, acceptability, and preliminary effect of a novel deliberate practice intervention to reduce diagnostic error in trauma triage: a study protocol for a randomized pilot trial.Pilot and feasibility studies · 2022Article
- Association of Practitioner Interfacility Triage Performance With Outcomes for Severely Injured Patients With Fee-for-Service Medicare Insurance.JAMA surgery · 2019Article
- Does Preexisting Practice Modify How Video Games Recalibrate Physician Heuristics in Trauma Triage?The Journal of surgical research · 2019Article
Corrections and comments
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Authors and funding
8 authors.
Funding
Abstract
backgroundUnder-triage of severely injured patients presenting to non-trauma centers (failure to transfer to a trauma center) remains problematic despite quality improvement efforts. Insights from the behavioral science literature suggest that physician heuristics (intuitive judgments), and in particular the representativeness heuristic (pattern recognition), may contribute to under-triage. However, little is known about how the representativeness heuristic is instantiated in practice.
methodsA multi-disciplinary group of experts identified candidate characteristics of "representative" severe trauma cases (e.g., hypotension). We then reviewed the charts of patients with moderate-to-severe injuries who presented to nine non-trauma centers in western Pennsylvania from 2010-2014 to assess the association between the presence of those characteristics and triage decisions. We tested bivariate associations using χ2 and Fisher's Exact method and multivariate associations using random effects logistic regression.
resultsWe identified 235,605 injured patients with 3,199 patients (1%) having moderate-to-severe injuries. Patients had a median age of 78 years (SD 20.1) and mean Injury Severity Score of 10.9 (SD 3.3). Only 759 of these patients (24%) were transferred to a trauma center as recommended by the American College of Surgeons clinical practice guidelines. Representative characteristics occurred in 704 patients (22%). The adjusted odds of transfer were higher in the presence of representative characteristics compared to when they were absent (aOR 1.7, 95% CI: 1.4-2.0, p < 0.001).
conclusionsMost moderate-to-severely injured patients present without the characteristics representative of severe trauma. Presence of these characteristics is associated with appropriate transfer, suggesting that modifying physicians' heuristics in trauma may improve triage patterns.
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