The Magic Number: Are Improved Outcomes Observed at Trauma Centers with Undertriage Rates Below 5 Percent?

BACKGROUND The American College of Surgeons Committee on Trauma (ACSCOT) advises trauma centers maintain 5% UTR. We hypothesized that similar overall adjusted outcomes would be observed at trauma centers in Pennsylvania regardless of their compliance with ACSCOT undertriage recommendation. METHODS The Pennsylvania Trauma Outcome Study (PTOS) database was retrospectively queried for all trauma patients managed at accredited adult Level I/II trauma centers (n=27) from 2003-2015. Patients with missing data on Injury Severity Score (ISS) and/or Trauma Activation Status were excluded from the analysis. Institutional undertriage rates (UTR) were calculated for all trauma centers based on ACSCOT criteria (ISS >15; no Trauma Activation) and were categorized into 5% subgroups. A multilevel mixed-effects logistic regression model assessed the adjusted impact of management at centers with 5%. No clinically meaningful difference in unadjusted mortality rate was observed between subgroups (5% UTR: 5.20%; p5% UTR (AOR: 1.06; 95% CI: 0.85-1.33; p = 0.608). CONCLUSIONS Achieving ACSCOT

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