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Gender affects triage as well as outcomes in trauma patients

OCTOBER 24, 2018
Clinical Congress Daily Highlights, Wednesday First Edition

Female trauma patients are less likely to end up in a higher-level trauma center and the undertriaged women were less likely to be discharged home compared with men, a study presented Wednesday finds.

Caroline Park, MD, Keck School of Medicine of USC, Los Angeles, CA, said that many studies have looked at gender and patient outcomes, offering traumatic brain injury and critical care as two examples. But she noted that there are no studies on gender that consider triage patterns.

To address this issue, her team conducted a retrospective analysis of the National Trauma Database Bank (NTDB) between 2008–2015 that examined the relationship between gender, trauma triage patterns, and outcomes in adults meeting the CDC criteria for field triage to Level I or Level II high-level trauma centers (HLTC).

Of the 214,847 patients identified, more females were undertriaged to non-high level trauma centers (NHLTC) than males (5.4 percent vs. 4.7 percent, p-value less than 0.001). Interestingly, this effect was most pronounced in the Midwest, possibly due to the smaller number of HLTCs in this region, Dr. Park postulated.

In addition, females triaged to NHLTCs were significantly older compared to males (60 vs. 47 years, p-value less than 0.0001) and more likely to present with blunt injury (88.9 percent vs. 72.2 percent, p-value less than 0.0001). In-hospital mortality rates and ICU length of stay were decreased in NHLTC females (4.6 percent vs. 5.5 percent, p-value less than 0.001). However, undertriaged females were less likely to be discharged home (48.8 percent vs. 55.4 percent, p-value less than 0.001).

Dr. Park suggested that the lower discharge rates for NHLTC females could result from limited support systems for elderly patients after discharge, or because their injury burden is underestimated at the outset. She argued that to better improve outcomes we need to identify the barriers that prevent these patients from being discharged home.

When asked why mortality rates were decreased in NHLTC females if more of them are undertriaged, Dr. Park noted that the researchers were not able to access long-term outcome data for these patients, which would more fully inform mortality rates. She explained that the mortality rate could be higher, as many patients are sent to long-term care facilities after trauma treatment, and may not do as well there.

Dr. Park said that further research should be done to elucidate long-term patient outcomes and reasons for  inadequate triage of female patients. She said that improving prehospitalization analysis and education as well as identifying barriers to discharging female trauma patients could address these issues.

View this study’s abstract online here.

Additional information

The Scientific Forum, Gender Matters: Under-triage of Female Patients to High Level Trauma Centers Affects Outcomes, was held October 24, at the 2018 Clinical Congress of the American College of Surgeons in Boston, MA. Program, webcast and audio information is available at

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