Secondary Overtriage More Common in Pediatric Patients

Discharging patients within day of transfer without surgery linked to significant costs
By Eric Metcalf
HealthDay Reporter

MONDAY, Sept. 13 (HealthDay News) -- Secondary overtriage -- involving rapid discharge after transferring a patient between hospitals -- appears more common in pediatric patients, and may come at a considerable cost to the health care system, according to research published in the September issue of the Journal of Trauma.

Hayley B. Osen, of the Johns Hopkins School of Medicine in Baltimore, and colleagues analyzed data from the Nationwide Inpatient Sample from 2000 to 2004. They focused on trauma patients admitted as transfers from another hospital, and defined secondary overtriage as patients discharged alive within a day after transfer without receiving a surgical procedure.

The researchers found a 6.9 percent rate of secondary overtriage, with an increasing trend over time. The rate was notably higher among patients under the age of 18 (19.5 versus 4.2 percent). In multivariate analysis, factors associated with a higher chance of rapid discharge after transfer included younger age, lack of insurance, and being transferred to a teaching hospital. The authors write that there are significant direct and indirect costs associated with secondary overtriage.

"In conclusion, secondary overtriage is more common in pediatric patients than adults, and likely the result of uneven distribution of specialists and resources related to care of pediatric trauma patients. In addition, the fear of litigation may also play a role. These important topics must be addressed carefully as we identify our nation's health care spending priorities," the authors conclude.

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