A difficult balance has to be achieved between undertriage, where patients likely to substantially benefit from ICU admission are not afforded this opportunity, leading to adverse outcomes, and overtriage
, where patients who are unlikely to benefit from intensive care are admitted, resulting in an inappropriate utilisation of resources.
Under the ACC payment systems focusing on transporting live injured patients, EMS providers were incentivised to overtriage
practices and perceived pressure to transport patients.
Overtriage was defined as the proportion of children triaged into the high triage priority, who were not hospitalized.
found an undertriage of 22 %, an overtriage of 29 %, and a corresponding sensitivity of 78 % for the pediatric subgroup, using hospitalization as primary outcome .
Overtriage will have minimal adverse consequences for the patients but may cause interruptions and can possibly wear out health care providers working in the ED.
Kestler, "Reduced overtriage and undertriage with a new triage system in an urban accident and emergency department in Botswana: A cohort study," Emergency Medicine Journal, vol.
A total of 7.6% of all errors is overtriage
and 25.3% is under-triage.
American College of Surgeons (ACS) secondary trauma triage guidelines state that a 10% undertriage rate is acceptable and a 50% overtriage
or false-positive rate is unavoidable in order to capture as many at-risk patients as possible, Dr.
The American College of Surgeons Committee on Trauma (ACSCOT) guideline suggests that threshold indicators for overtriage
would be acceptable up to 50%, and 10% for under-triage.