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An Activation Failure: Factors Associated With Undertriage of Pediatric Major Trauma Victims
Jillian Gorski1, Seth Goldstein2, Suhail Zeineddin2
1Division of Pediatric Emergency Medicine, Department of Emergency Medicine, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin.
Insights
Many children with major trauma are undertriaged, especially those with blunt injury mechanisms like falls. This highlights a need for better risk-stratification systems to identify pediatric trauma patients accurately.
Area of Science:
- Pediatric Trauma Care
- Emergency Medicine
- Public Health
Background:
- Undertriage of pediatric major trauma victims is a significant concern, leading to adverse clinical outcomes.
- Accurate triage is crucial for ensuring optimal care for critically injured children.
Purpose of the Study:
- To identify factors associated with the undertriage of pediatric patients experiencing major trauma.
- To inform the development of improved triage protocols for children.
Main Methods:
- Retrospective cross-sectional study using the 2021 American College of Surgeons National Trauma Data Bank.
- Inclusion of children (<16 years) meeting major trauma criteria via the Standard Triage Assessment Tool.
- Multivariable logistic regression analysis to determine undertriage predictors.
Main Results:
- 5.3% of 97,812 children met major trauma criteria; 34.4% of these were undertriaged.
- Undertriage was linked to fall/striking mechanisms, missing vital signs, private vehicle transport, and interfacility transfers.
- Factors reducing undertriage included signs of severe injury (hypotension, altered consciousness) and advanced care (intubation, flight arrival).
Conclusions:
- A substantial proportion of pediatric major trauma patients are undertriaged, particularly those with seemingly lower-risk blunt mechanisms.
- Development of refined risk-stratification tools is essential for accurate identification of pediatric major trauma, especially for blunt injuries.
Introduction:
Undertriage of children contributes to poorer clinical outcomes. The objective of this study was to determine factors associated with undertriage of pediatric major trauma victims.
Methods:
We performed a retrospective cross-sectional study of children (aged < 16 ys) using the 2021 American College of Surgeons National Trauma Data Bank. We identified children who met the definition of major trauma defined by the Standard Triage Assessment Tool. We performed multivariable logistic regression to determine factors associated with undertriage, defined as encounters which met criteria, but did not receive highest-level activation.
Results:
Of 97,812 included children, 5.3% met major trauma criteria. Undertriage occurred in 34.4% of encounters with major trauma. Factors associated with undertriage included fall and striking mechanisms, missing blood pressure, private vehicle arrival, and incoming interfacility transfers. Hypotension, decreased level of consciousness, prehospital and in-hospital intubation, tachycardia, hypothermia, penetrating mechanism, presentation to a pediatric level 2 or adult level 1 trauma center relative to pediatric level 1 center, and arrival by flight were associated with lower odds of undertriage.
Conclusions:
Many children with major trauma were undertriaged, particularly those presenting with lower-risk histories, such as private vehicle arrivals and fall mechanisms. Future work should seek to develop risk-stratification systems that can better identify children with major trauma, with an emphasis on those with blunt traumatic mechanisms.
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