Factors Associated with Secondary Overtriage in Renal Trauma.

<bold>Objective: </bold>To examine secondary overtriage for isolated renal trauma patients and to use secondary overtriage criteria to determine factors associated with unnecessary interhospital transfers in patients with isolated renal trauma.<bold>Methods: </bold>The National Trauma Data Bank was used to identify isolated renal trauma patients of any age who were transferred to a level I or II trauma center from 2007 to 2014. Secondary overtriage criteria were defined as hospital length of stay <72 hours, no ICU admission, no emergent transfer from the ED to the OR, no operating room procedure, and no renal IR/OR procedure. Adjusted risk ratios (RR) and 95% confidence intervals were estimated using Poisson regression.<bold>Results: </bold>A total of 8156 isolated renal injury patients who were transferred to either a level I or II trauma center were identified. More than half (53%) of the transferred patients had low-grade renal injuries (American Association for the Surgery of Trauma (AAST) Grade I/II). Our definition of secondary overtriage was met in 3005 patients (37%). In this group, 59% had low-grade renal injuries. The risk of being overtriaged was significantly reduced with increasing renal injury grade, hypotension in the emergency department, firearm injuries, older age (>65 years), medicare payer status, and any substance abuse.<bold>Conclusion: </bold>Secondary overtriage is common in isolated renal trauma. Factors associated with secondary overtriage are age ≤65 years, falls, and low renal injury grade. The high rate of unnecessary transfers shows that there is a need for disease-specific transfer guidelines to assure safe, cost-effective, and efficient health care in isolated renal trauma. [ABSTRACT FROM AUTHOR]