Optimizing Triage Practice in Pediatric Trauma: Lessons From Under-triage and Over-triage Rates and Risk Factors

Area of Science:

• Pediatric Trauma Care
• Emergency Medicine
• Injury Prevention

Background:

• Accurate triage is critical for effective pediatric trauma care.
• Unique challenges exist in assessing pediatric trauma severity.
• Understanding triage inaccuracies is vital for improving outcomes.

Purpose of the Study:

• To investigate risk factors for under-triage and over-triage.
• To analyze pediatric trauma activations at an urban trauma center.
• To identify specific patient groups and injury mechanisms associated with triage errors.

Main Methods:

• Retrospective cohort study of pediatric trauma activations (<18 years old).
• Data collected from January 2021 to July 2023 at a Level 1 trauma center.
• Under- and over-triage identified using trauma activation level and Injury Severity Score.

Main Results:

• 1094 trauma activations analyzed; under-triage rate 3.8%, over-triage rate 13.6%.
• Infants (0-1 years) had highest under-triage (10.9%); adolescents (11-17 years) had highest over-triage (17.0%).
• Non-accidental trauma strongly predicted under-triage (OR 30.2); penetrating mechanisms predicted over-triage (OR 12.2).

Conclusions:

• Pediatric trauma triage is complex, with distinct age-related patterns.
• Age, comorbidities, and injury mechanism are key predictive factors.
• Findings can refine triage practices to enhance pediatric trauma patient care.