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Consequences of pediatric undertriage and overtriage in a statewide trauma system
Hilary A Hewes1, Mathew Christensen, Peter P Taillac
1From the Division of Pediatric Emergency Medicine (H.A.H., K.K.J.), University of Utah School of Medicine, Salt Lake City, Utah; Bureau of Emergency Medical Services and Preparedness (M.C.), Utah Department of Health, Salt Lake City, Utah; Division of Emergency Medicine (P.P.T.), University of Utah School of Medicine, Salt Lake City, Utah; Department of Pediatrics (N.C.M.), University of Utah School of Medicine, Salt Lake City, Utah; and Division of Pediatric Surgery (S.J.F.), University of Utah School of Medicine, Salt Lake City, Utah.
Insights
Evaluating trauma triage in Utah
Area of Science:
- Trauma care systems
- Pediatric emergency medicine
- Health services research
Background:
- Healthcare quality evaluation is crucial for optimizing emergency care.
- Trauma triage decisions impact patient outcomes and costs.
- Improving trauma systems can reduce mortality and morbidity.
Purpose of the Study:
- To quantify undertriage and overtriage in pediatric trauma patients within a statewide system.
- To assess the relationship between triage decisions and patient outcomes.
- To identify opportunities for improving pediatric trauma care delivery.
Main Methods:
- Statewide, population-based evaluation of pediatric trauma outcomes.
- Analysis of interfacility transfer patterns from 2001-2013.
- Involved 45 hospitals in Utah's trauma system.
Main Results:
- Undertriage criteria hospitals had 13 times lower odds of pediatric transfer.
- Triage practice was a stronger predictor of transfer than injury severity or age.
- Pediatric trauma mortality was more than twice higher in undertriage hospitals.
Conclusions:
- Significant potential exists to enhance pediatric trauma patient transfer practices.
- Improvements can reduce pediatric trauma mortality and associated healthcare costs.
- Optimizing triage decisions is key to better patient outcomes.
Background:
With increasing attention to the quality of health care delivery, evaluating trauma triage decisions in a large system of emergency care can help decision makers reduce mortality, morbidity, unnecessary transfers, and health care costs.
Objectives:
To quantify the magnitude of pediatric traumatic injury undertriage (hospital mortality risk) and overtriage (early trauma center discharge after transfer) in a statewide trauma system.
Methods:
A statewide population-based evaluation of pediatric trauma outcomes and secondary triage (interfacility transfers) patterns from 2001 to 2013 among 45 hospitals in Utah's statewide trauma system.
Results:
The odds of pediatric transfer were 13 times lower (odds ratio, 13.15; p < 0.0001; 95% confidence interval, 11.0-15.7) in acute care hospitals meeting undertriage criteria than hospitals meeting overtriage criteria. Hospital triage practice was a stronger predictor of pediatric transfer than injury severity, injury diagnoses, age, and geographic distance. The likelihood of pediatric trauma mortality was more than twice higher in undertriage hospitals than overtriage hospitals (OR, 2.44; p < 0.0001; 95% confidence interval, 1.5-3.8). Among pediatric patients that survived the injury to transfer, 61% were discharged from the pediatric center in < 24 hours.
Conclusion:
Substantial opportunity exists in the state trauma system to improve pediatric trauma patient transfer practices to reduce pediatric trauma mortality, morbidity, and health care costs associated with unnecessary transfers.
Level Of Evidence:
Prognostic and epidemiological, level III.
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