Why Is Treatment Urgency Often Overestimated? An Experimental Study on the Phenomenon of Over-triage

Abstract

In the 19th century, triage emerged as an administrative concept to overcome the unjust and medically unreasonable consequences of an unsystematic adhoc selection of casualties. Until today, however, triage concepts are often applied incorrectly. High over-triage rates are a well-known phenomenon, which increase mortality rates. In order to examine their frequent occurrences, the article discusses different reasons and presents results of an experimental study. Two triage exercises were conducted: a paper-based triage exercise and a real-world simulation. Both exercises used the same case-vignettes consisting of 5 pairs. Each pair described a patient with the same injury pattern and vital parameters but with differing behaviour (calm/highly excited). Different behavior has a minor but no significant effect on over-triage rates. Over-triage is significantly higher in the real-world simulation than in the paper exercise. This is explained by the characteristics of face-to-face situations themselves: they are more complex and ambiguous, and hold more normative power. Accordingly, over-triage is understood as a means to resolve unclear situations (better to over- than to under-triage) and to comply with normative demands within the strict margins of an administrative concept.