AI algorithms may excel in trauma triage but show concerning undertriage risks, notably in older adults.

• Sensitivity for major trauma detection was 89.4% with a specificity of 86.5%.
• Geriatric patients experienced a 17.6% undertriage rate, significantly higher than 5.2% in younger adults (p = .012).
• Theoretical delays of 18.5 minutes linked to undertriage affected 14.2% of major trauma cases.

Use AI as a supervised tool rather than relying on it solely for critical triage decisions.