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Effect of the 2011 Revisions to the Field Triage Guidelines on Under- and Over-Triage Rates for Pediatric Trauma
Insights
The 2011 Field Triage Guidelines for pediatric trauma care increased under-triage compared to older versions, indicating a need for better identification of children requiring trauma center resources. This study highlights challenges in emergency medical services (EMS) triage for injured children.
Area of Science:
- Pediatric emergency medicine
- Trauma care systems
- Emergency medical services (EMS)
Background:
- Revised Field Triage Guidelines were released in 2011 by the CDC and ACS-COT.
- The impact of these revised guidelines on identifying injured children needing trauma center transport by EMS is unknown.
Purpose of the Study:
- To compare under- and over-triage rates using the 2011 Field Triage Guidelines against the 2006 and 1999 versions.
- To assess the effectiveness of current triage guidelines in identifying pediatric trauma patients.
Main Methods:
- EMS providers were interviewed regarding injured children (<15 years) transported to trauma centers.
- Patient demographics and triage criteria were collected, and outcomes were tracked through hospital discharge.
- The 1999, 2006, and 2011 Guidelines were retrospectively applied to the collected data.
Main Results:
- The 2011 Guidelines showed an 8.2% increase in under-triage and a 4.6% decrease in over-triage compared to the 1999 Guidelines.
- Under-triage rates were 34.8% with the 2011 Guidelines, 35.1% with 2006, and 26.5% with 1999.
- Over-triage rates were 28.0% with 2011, 27.9% with 2006, and 32.6% with 1999.
Conclusions:
- The Field Triage Guidelines, regardless of version, result in unacceptably high under-triage rates for injured children.
- The 2011 Guidelines appear to increase under-triage compared to the 1999 version.
- Further research is necessary to improve EMS identification of pediatric patients requiring trauma center care.
Background:
In 2011, revised Field Triage Guidelines were released jointly by the Centers for Disease Control and Prevention (CDC) and the American College of Surgeons - Committee on Trauma (ACS-COT). It is unknown how the modifications will affect the number of injured children identified by EMS providers as needing transport to a trauma center.
Objective:
To determine the change in under- and over-triage rates when the 2011 Field Triage Guidelines are compared to the 2006 and 1999 versions.
Methods:
EMS providers in charge of care for injured children (<15 years) transported to pediatric trauma centers in 3 mid-sized cities were interviewed immediately after completing transport. Patients were included regardless of injury severity. The interview included patient demographics and each criterion from the Field Triage Guidelines' physiologic status, anatomic injury, and mechanism of injury steps. Included patients were followed through hospital discharge. The 1999, 2006, and 2011 Guidelines were each retrospectively applied to the collected data. Children were considered to have needed a trauma center if they had non-orthopedic surgery within 24 hours, ICU admission, or died. Data were analyzed using descriptive statistics.
Results:
EMS interviews were conducted for 5,610 children and outcome data was available for 5,594 (99.7%). Average age was 7.6 years; 5% of children were identified as needing a trauma center using the study outcome. Applying the 1999, 2006, or 2011 Guidelines to the EMS interview data the over-triage rate was 32.6%, 27.9%, and 28.0%, respectively. The under-triage rate was 26.5%, 35.1%, and 34.8%, respectively. The 2011 Guidelines resulted in an 8.2% (95% CI 0.6-15.9%) absolute increase in under-triage and a 4.6% (95% CI 2.8-6.3%) decrease in over-triage compared to 1999 Guidelines.
Conclusion:
Use of the Field Triage Guidelines for children resulted in an unacceptably high rate of under-triage regardless of the version used. Use of the 2011 Guidelines increased under-triage compared to the 1999 version. Research is needed to determine how to better assist EMS providers in identifying children who need the resources of a trauma center.
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