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Undertriage of Pediatric Major Trauma Patients in the United States
Jin Peng1,2, Krista Wheeler1, Jonathan I Groner1,3,4
11 Center for Pediatric Trauma Research, The Research Institute at Nationwide Children's Hospital, Columbus, OH, USA.
Insights
Pediatric trauma undertriage affects 21.7% of major trauma cases. Rural children and those uninsured face higher undertriage risks, highlighting disparities in pediatric trauma care access.
Area of Science:
- Emergency Medicine
- Pediatric Surgery
- Public Health
Background:
- Trauma undertriage is a known issue, but understudied in pediatric populations.
- Accurate triage is critical for timely and appropriate trauma care.
Purpose of the Study:
- To determine the national undertriage rate in pediatric major trauma patients.
- To identify factors associated with undertriage in this demographic.
Main Methods:
- Analysis of the 2009-2013 Nationwide Emergency Department Sample.
- Inclusion criteria: pediatric patients (age ≤16 years) with Injury Severity Score (ISS) >15.
Main Results:
- A national undertriage rate of 21.7% was observed for pediatric major trauma.
- Children in rural areas and those without insurance were more likely to be undertriaged.
- Patients with life-threatening injuries or chronic conditions were less likely to be undertriaged.
Conclusions:
- Significant undertriage exists in pediatric major trauma.
- Disparities in undertriage are linked to socioeconomic and geographic factors.
- Innovative care models are needed to improve pediatric trauma triage and outcomes.
Abstract:
Although trauma undertriage has been widely discussed in the literature, undertriage in the pediatric trauma population remains understudied. Using the 2009-2013 Nationwide Emergency Department Sample, we assessed the national undertriage rate in pediatric major trauma patients (age ≤16 years and injury severity score [ISS] >15), and identified factors associated with pediatric trauma undertriage. Nationally, 21.7% of pediatric major trauma patients were undertriaged. Children living in rural areas were more likely to be undertriaged ( P = .02), as were those without insurance ( P = .00). Children with life-threatening injuries were less likely to be undertriaged ( P < .0001), as were those with chronic conditions ( P < .0001). Improving access to specialized pediatric trauma care through innovative service delivery models may reduce undertriage and improve outcomes for pediatric major trauma patients.
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