Estimations from studies in the US and Europe indicate rates around 20–60%. Unfortunately, the rate of undertriage is much higher. Prehospital undertriage occurs when a severely injured patient, Injury Severity Score (ISS) > 15, is transported to a facility that lacks the required level of appropriate care, and should be less than 5%. In many countries, the policy is to transport severely injured patients directly to trauma centers, even if it means bypassing lower level care facilities in closer proximity. International studies indicate that treating severely injured patients at trauma centers, which are better equipped to provide adequate care, is associated with a reduced mortality of 15–32%. Trauma systems vary considerably in different parts of the world, with diverse policies concerning transport destination of the injured patient. This can be accomplished by streamlining the prehospital chain and, with minimum delay, provide treatment at specialized trauma centers. Many deaths are preventable with more effective and fast treatment. Trauma is a major cause of mortality, responsible for 9% of global deaths and the primary reason for loss of life in young people.
This study motivates a critical review and possible reorganization of the national trauma system, and further research to identify the characteristics of patients in most need of specialized care. There exists a potentially substantial survival benefit for trauma patients treated at trauma centers in Sweden, especially for the most severely injured. Treatment at a trauma center in Sweden was associated with a 41% lower adjusted 30-day mortality (odds ratio 0.59, p 70% mortality decrease for the most critically injured group (ISS ≥ 50). Logistic regression was used to analyze the effect of trauma center care on mortality rate, while adjusting for other factors potentially affecting the risk of death. University hospitals were classified as trauma centers other hospitals as non-trauma centers. Three sampling exclusion criteria were applied: (1) Injury Severity Score (ISS) of zero (2) missing data in any variable of interest (3) data falling outside realistic values and duplicate registrations. This retrospective study included 29,864 patients from the national Swedish Trauma Registry (SweTrau) during the period 2013–2017. The secondary objective was to evaluate how injury severity influences the potential survival benefit of specialized care. The main objective was to compare the 30-day mortality rate of trauma patients treated at trauma centers as compared to non-trauma centers in Sweden.
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