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An analysis of pediatric trauma center undertriage in a mature trauma system

Amelia T Rogers1, Michael A Horst, Tawnya M Vernon

  • 1From the General Surgery Residency, University of Louisville, Louisville, Kentucky (A.T.R.); Trauma and Acute Care Surgery, Penn Medicine Lancaster General Health, Lancaster, Pennsylvania (M.A.H., T.M.V., E.H.B., S.J., F.B.R.); and Department of Surgery (B.A.G.), UPMC Children's Hospital of Pittsburg, Pittsburg, Pennsylvania, Trauma Research Program (A.D.C.), Chandler Regional Medical Center, Chandler, Arizona.

The Journal of Trauma and Acute Care Surgery
|March 20, 2019
PubMed

Insights

Pennsylvania pediatric trauma patients experience a high undertriage rate (UTR) of 45.8%. Undertriage is concentrated in eastern Pennsylvania, suggesting a systemic issue rather than access problems for injured children.

Area of Science:

  • Trauma Surgery
  • Pediatric Emergency Medicine
  • Health Services Research

Background:

  • Appropriate triage significantly improves mortality in adult trauma patients.
  • The benefits of established adult trauma triage protocols may extend to pediatric populations.
  • Understanding undertriage rates in pediatric trauma is crucial for optimizing care.

Purpose of the Study:

  • To determine the overall undertriage rate (UTR) in the pediatric trauma population within Pennsylvania (PA).
  • To identify geographic patterns and potential contributing factors to pediatric trauma undertriage in PA.

Main Methods:

  • Retrospective analysis of pediatric trauma admissions (age < 15) in Pennsylvania from 2003-2015.
  • Data extracted from the Pennsylvania Health Care Cost Containment Council (PHC4) and Pennsylvania Trauma Systems Foundation (PTSF) registries.
  • Geospatial mapping using ArcGIS Desktop to visualize undertriage patterns.

Main Results:

  • A total of 37,607 cases in PTSF and 63,954 in PHC4 met trauma criteria, yielding an overall UTR of 45.8% in PA.
  • Geospatial analysis revealed significant undertriage clusters in eastern PA, contrasting with lower rates in the west.
  • High undertriage rates were observed around non-pediatric trauma facilities, particularly in densely populated areas.

Conclusions:

  • Pediatric trauma undertriage in Pennsylvania is substantial, with a notable geographic clustering in the eastern part of the state.
  • The pattern of undertriage, concentrated around existing trauma centers in populated areas, suggests a system-level issue.
  • Findings indicate that the undertriage problem may stem from systemic factors within trauma care delivery rather than solely from access limitations.
Abstract

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