European Journal of Trauma and Emergency Surgery

, Volume 45, Issue 5, pp 821–839 | Cite as

Determination of mis-triage in trauma patients: a systematic review

  • Zohre Najafi
  • Abbas Abbaszadeh
  • Hossein Zakeri
  • Amir MirhaghiEmail author
Review Article



Mis-triage including undertriage and overtriage is associated with morbidity and mortality. It is not clear what the extent of mis-triage rates among traumatic patients is. The aim of this study is to determine of mis-triage (undertriage and overtriage) in traumatic patients.


This study was a systematic review about mis-triage rate among trauma patients. The following electronic databases were searched (Web of Knowledge, Scoups, PubMed, Cochrane library) from conception through February 1, 2018. Search terms included trauma, undertriage, and over-triage. Inclusion criteria were studies which report overtriage or undertriage rate in regard to triage of trauma patients; patients older than 18 years old, English-written papers. Irrelevant papers as well as conference abstract, letter, editorial, thesis and studies on special population were excluded. PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) Checklist was used to examine review process.


Twenty-one papers were included in this study. Sample size ranged from 244 to 550683 trauma patients. Fourteen studies originated from USA. Definition of mis-triage was summarized into four categories: ISS used to define undertriage error, formula for mis-triage (1—sensitivity), need for life-saving emergency intervention and patients triaged to a non-trauma center. Undertriage rate ranged from 1 to 71.9% and overtriage rate ranged from 19 to 79%.


The standardization of mis-triage definitions is vital to estimate true rate of mis-triage among different studies and clarify the role of triage scales. The trauma triage scales need to be further developed to provide more valid and reliable results.


Triage Undertriage Over-triage Emergency Trauma 



This project was supported by funding from Shahid Beheshti University of Medical Sciences.

Compliance with ethical standards

Conflict or interest

No conflict of interest has been declared by the authors.


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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Department of Nursing, Student Research Committee, School of Nursing and MidwiferyShahid Beheshti University of Medical SciencesTehranIran
  2. 2.Department of Medical-Surgical Nursing, School of Nursing and MidwiferyShahid Beheshti University of Medical SciencesTehranIran
  3. 3.Department of Emergency Medicine, Faculty of MedicineMashhad University of Medical SciencesMashhadIran
  4. 4.Nursing and Midwifery Care Research CenterMashhad University of Medical SciencesMashhadIran

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