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Pediatric trauma transport performance measures in a mountain state: adherence and outcomes
Stephen J Gleich1, Tellen D Bennett, Susan L Bratton
1Department of Pediatrics, University of Utah, Salt Lake City, Utah 84158-1289, USA. Stephen.Gleich@hsc.utah.edu
Insights
Many pediatric trauma patients experienced delays in triage, failing to meet state performance measures. Further research is needed to determine if adherence to these trauma care goals impacts patient outcomes.
Area of Science:
- Pediatric trauma care
- Emergency medicine
- Healthcare quality improvement
Background:
- Utah's trauma audit filters aim to ensure timely care for severely injured patients.
- Evaluating state performance measures for pediatric trauma care is crucial.
Purpose of the Study:
- To assess adherence to state performance measures for pediatric trauma care.
- To evaluate triage and transfer times for pediatric trauma patients.
Main Methods:
- Analysis of pediatric trauma patient data (Injury Severity Scores >15) from 2006-2009.
- Evaluation of emergency department triage time (<2 hours) and total transfer time (≤6 hours rural, ≤4 hours urban).
Main Results:
- 50% of pediatric trauma patients met the <2-hour triage goal; this rose to two-thirds within 100 miles of the trauma center.
- Delayed triage was associated with lower injury severity and greater distance.
- Adherence to transfer time goals was high for rural (94%) but lower for urban (76%) areas.
Conclusions:
- Substantial nonadherence to the <2-hour triage performance measure was observed for pediatric trauma patients.
- Low rates of poor outcomes prevented definitive conclusions on whether adherence to triage goals improves morbidity or mortality.
Background:
Utah state trauma audit filters assess expeditious care at referring emergency departments for severely injured patients to avoid delays in transfer. We evaluated two state performance measures related to pediatric trauma care before arrival at the Level I trauma center.
Methods:
Analysis of the Primary Children's Medical Center (PCMC) trauma database for children with Injury Severity Scores (ISS)>15 from 2006 to 2009 was performed. Patient care was evaluated for referring hospital emergency department triage time of <2 hours and total transfer time of ≤6 hours for rural and ≤4 hours for urban place of injury.
Results:
Four hundred twelve patients with ISS>15 were admitted via interhospital transfer from within Utah. Approximately 50% of patients were triaged<2 hours, which increased to almost two thirds when restricted to those initially evaluated within 100 miles (helicopter range) of PCMC. Factors associated with delayed triaged included lower ISS, less severe head injury, greater distance from the trauma center, and primary chest/abdominal injuries. Death and poor outcome did not differ significantly by triage in <2 hours or ≥2 hours. Adherence with the total transfer time goal was 94% for rural and 76% for urban place of injury.
Conclusions:
There was substantial nonadherence with trauma performance measures for triage in <2 hours among pediatric trauma patients with ISS >15. Because of low rates of poor outcome, we are unable to determine whether adherence with state triage goals lessens morbidity or mortality.
