ArticleThe journal of trauma and acute care surgery2020
Disparities in rural versus urban field triage: Risk and mitigating factors for undertriage.
Article in The journal of trauma and acute care surgery, 2020. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 15 papers.
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Who cites it
15 citing papers in PubMed, 32 citations in OpenAlex.
- Establishing a Consensus-Based Definition of Air Medical Transport Need for Rural Patients After Injury: Results from a Delphi Survey.Prehospital emergency care · 2026Article
- Secondary Undertriage in a Rural Trauma System: A Retrospective Study of Twice-Transferred Patients.The Journal of surgical research · 2025Article
- Exploring patient and system factors impacting undertriage of injured patients meeting national field triage guideline criteria.The journal of trauma and acute care surgery · 2025Article
- Optimizing mass casualty: an incident report of centralizing patient transport and its impact on triage efficiency.Journal of rural medicine : JRM · 2025Article
- Improving care and equity in the American trauma system: past, present and future.Trauma surgery & acute care open · 2025Article
- System-Level Variability in Trauma Center Utilization for Seriously Injured Older Adults.The Journal of surgical research · 2025Article
- Crossing the line: access to trauma care across state borders.Trauma surgery & acute care open · 2024Article
- Failure to initiate trauma team activation for patients who meet the criteria in a level 1 paediatric trauma centre: which patients are missing out?ANZ journal of surgery · 2022Article
- Article
- Do new trauma centers provide needed or redundant access? A nationwide analysis.The journal of trauma and acute care surgery · 2022Article
- Neuroethics across the Disorders of Consciousness Care Continuum.Seminars in neurology · 2022Review
- Society for Surgery of the Alimentary Tract Health Care Quality and Outcomes Committee Webinar: Addressing Disparities.Journal of gastrointestinal surgery : official journal of the Society for Surgery of the Alimentary Tract · 2022Article
- Regular feedback on inter-hospital transfer improved the clinical outcome and survival in patients with multiple trauma: a retrospective cohort study.BMC emergency medicine · 2021Article
- The need for craniofacial trauma and oncologic reconstruction in global surgery.Journal of oral biology and craniofacial researchArticle
- A Systematic Literature Review of Trauma Systems: An Operations Management Perspective.Advances in rehabilitation science and practiceReview
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Authors and funding
6 authors at 1 institution in 1 country.
Funding
Abstract
backgroundThere are well-known disparities for patients injured in rural setting versus urban setting. Many cite access to care; however, the mechanisms are not defined. One potential factor is differences in field triage. Our objective was to evaluate differences in prehospital undertriage (UT) in rural setting versus urban settings.
methodsAdult patients in the Pennsylvania Trauma Outcomes Study (PTOS) registry 2000 to 2017 were included. Rural/urban setting was defined by county according to the Pennsylvania Trauma Systems Foundation. Rural/urban classification was performed for patients and centers. Undertriage was defined as patients meeting physiologic or anatomic triage criteria from the National Field Triage Guidelines who were not initially transported to a Level I or Level II trauma center. Logistic regression determined the association between UT and rural/urban setting, adjusting for transport distance and prehospital time. Models were expanded to evaluate the effect of individual triage criteria, trauma center setting, and transport mode on UT.
resultsThere were 453,112 patients included (26% rural). Undertriage was higher in rural patients (8.6% vs. 3.4%, p < 0.01). Rural setting was associated with UT after adjusting for distance and prehospital time (odds ratio [OR], 3.52; 95% confidence interval [CI], 1.82-6.78; p < 0.01). Different triage criteria were associated with UT in rural/urban settings. Rural setting was associated with UT for patients transferred to an urban center (OR, 3.32; 95% CI, 1.75-6.25; p < 0.01), but not a rural center (OR, 0.68; 95% CI, 0.08-5.53; p = 0.72). Rural setting was associated with UT for ground (OR, 5.01; 95% CI, 2.65-9.46; p < 0.01) but not air transport (OR, 1.18; 95% CI, 0.54-2.55; p = 0.68).
conclusionUndertriage is more common in rural settings. Specific triage criteria are associated with UT in rural settings. Lack of a rural trauma center requiring transfer to an urban center is a risk factor for UT of rural patients. Air medical transport mitigated the risk of UT in rural patients. Provider and system interventions may help reduce UT in rural settings. LEVEL OF EVIDENCE: Care Management, Level IV.
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