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Cosmetic Surgery

Trauma Management

OMS and Other Dental Specialists

Residents

Session: Trauma and Cosmetic Track: Hot-off-the-Press and Abstract Session

GP3b - Trends and Predictors of Secondary Overtriage Among Adults Transferred for Isolated Facial Trauma in the United States

Friday, October 2, 2026

11:05 AM - 11:15 AM PDT

Oral Abstract Presenter(s)

Tim T. Wang, DMD, MD, MPH

Resident in Oral and Maxillofacial Surgery
Massachusetts General Hospital
Boston, Massachusetts

Co-Author(s)

Lang Liang, DMD

Resident in Oral and Maxillofacial Surgery
Massachusetts General Hospital
Boston, Massachusetts
NW

Nicholas Wilken, DDS, MD

Assistant Professor of Oral and Maxillofacial Surgery
University of Maryland Medical Center
Baltimore, Maryland
Zachary S. Peacock, DMD, MD, FACS

Chair
Massachusetts General Hospital
Boston, Massachusetts
Gary Warburton, DDS, MD

Professor of Oral and Maxillofacial Surgery
University of Maryland Medical Center
Baltimore, Maryland
John F. Caccamese, Jr., DMD, MD (he/him/his)

Professor
Department of Oral and Maxillofacial Surgery, University of Maryland School of Dentistry
Baltimore, Maryland
Cameron C. Lee, DMD, MD

Assistant Professor, Oral and Maxillofacial Surgery
University of Maryland
Baltimore, Maryland

Abstract: Background: Secondary overtriage of patients with isolated facial fractures is common and contributes to potentially avoidable healthcare costs. However, there is a dearth of data describing national trends and predictors of overtriage.

Purpose: The purpose of this study was to evaluate temporal trends in secondary overtriage among adults transferred for isolated facial fractures.

Study design, setting sample: This was a cross-sectional study using the American College of Surgeons National Trauma Data Bank from 2007 to 2023. Adults transferred for management of isolated facial fractures were included. Patients with missing data were excluded.

Predictor variable: The primary predictor was calendar year of transfer, modeled as both a categorical variable for descriptive analyses (2007-2015, 2016-2023) and a continuous variable for regression analyses.

Main outcome variable: The primary outcome was secondary overtriage, defined as transfer to a receiving emergency department followed by discharge home without surgical intervention for facial fractures or hospital admission.

Covariates: Covariates included demographic (age, race), clinical (Charlson Comorbidity Index), injury-related (fracture site), and hospital characteristics (teaching status, bed size).

Analyses: Descriptive, bivariate, and multivariable logistic regression statistics were performed to evaluate the association between calendar year and secondary overtriage.

Results: The cohort consisted of 110,157 subjects with a mean age of 44.6 ± 19.8 years and was 72.3% male (n = 79,690). A total of 30,583 (27.8%) subjects met criteria for secondary overtriage. Overtriage increased significantly over time from 11% in 2007 to 38% in 2023. Subjects treated from 2016 to 2023 were 1.65 times more likely to be overtriaged compared to those treated from 2007 to 2015 (95% CI: 1.61 to 1.70, P < .001). After adjustment for demographic, clinical, injury-related, and hospital covariates, each additional calendar year was associated with 12% increased odds of overtriage (OR 1.12, 95% CI: 1.11 to 1.12, P < .001). Overtriage was also independently associated with self-pay status (OR 1.74, 95% CI: 1.67 to 1.82), university hospitals (OR 1.65, 95% CI: 1.55 to 1.76), and larger hospitals with > 600 beds (OR 1.54, 95% CI: 1.38 to 1.72) (all P < .001). Conversely, mandibular fractures were associated with substantially lower odds of overtriage (OR 0.22, 95% CI: 0.19 to 0.26, P < .001).

Conclusions and Relevance: Secondary overtriage has increased substantially over time and remains common, affecting over one-third of transferred patients.

Figure 1. Summary of patient selection protocol.

Figure 2. Temporal trends in secondary overtriage with respect to time. The incidence of secondary overtriage increased steadily over the study period, from 11% in 2007 to a high of 38% in 2023. The vertical dashed line denotes the transition between the early (2007-2015) and late (2016-2023) study periods.

Figure 3. Temporal trends in secondary overtriage with respect to time. The black line represents strict secondary overtriage, defined as discharge home from the emergency department without operative intervention for facial fractures. The blue line represents an expanded definition, defined as hospital admission for fewer than two days without intensive care unit admission or operative intervention for facial fractures. Across the study period, annual expanded overtriage rates were consistently higher than rates observed using the strict definition, with the gap between definitions (shaded grey) ranging from approximately 5 to 16 percentage points depending on the year.