Related Experiment Video
Updated: May 26, 2025
A Modified Sonographic Algorithm for Image Acquisition in Life-Threatening Emergencies in the Critically Ill Newborn
Published on: April 7, 2023
Improving paediatric undertriage in a regional trauma network - A registry cohort study
François-Xavier Ageron1, Jean-Noël Evain2, Julie Chifflet2
1Emergency Department, Lausanne University Hospital, Lausanne, Switzerland.
Insights
A revised pediatric triage rule significantly reduced undertriage in major pediatric trauma cases, lowering the rate to 9%. This improved patient care by ensuring more children with severe injuries reach specialized trauma centers.
Area of Science:
- Pediatric Trauma Care
- Emergency Medicine
- Public Health
Background:
- Childhood trauma is a major global cause of mortality.
- Effective prehospital triage is vital for optimal management in pediatric trauma centers.
- Assessing undertriage rates is crucial for refining trauma system protocols.
Purpose of the Study:
- To evaluate the impact of a revised pediatric triage rule on undertriage rates.
- To identify predictors of undertriage in pediatric major trauma patients.
- To improve the accuracy of prehospital assessment for critically injured children.
Main Methods:
- Retrospective analysis of a multicenter registry of injured children (<15 years) with suspected major trauma.
- Assessment of triage performance before and after implementing a revised pediatric triage rule.
- Multivariate logistic regression to identify risk factors for undertriage.
Main Results:
- A total of 1524 children were included; 47.6% sustained major trauma.
- Undertriage decreased from 15% to 9% after the revised triage rule implementation.
- Risk factors for undertriage included older age, specific accident types, and injury patterns.
Conclusions:
- The revised regional triage rule effectively reduced pediatric undertriage to 9%.
- Specific clinical factors remain associated with undertriage, requiring continued vigilance.
- Optimized triage protocols enhance the likelihood of children with severe trauma accessing specialized care.
Background:
Trauma remains a leading cause of death in children worldwide. Management in dedicated paediatric trauma centres is beneficial, making accurate prehospital triage crucial. We assessed undertriage in a regional trauma system after implementing a revised paediatric triage rule.
Methods:
This retrospective, multicentre registry study included all injured children <15 years admitted to hospitals in the Northern French Alps with suspected major trauma and/or an Abbreviated Injury Scale ≥3. Triage performance was assessed before and after implementation of a revised paediatric triage rule. Multivariate logistic regression identified predictors of undertriage defined as a child with major trauma (need for trauma intervention) not directly transported to the paediatric trauma centre.
Results:
All 1524 injured children from January 2009 to December 2020 were included. Of these, 725/1524 (47.6%) presented with major trauma; 593/1524 (38.9%) were referred to a non-paediatric trauma centre, and 220/1524 (15%) were considered undertriaged. Over the years, undertriage decreased from 15% to 9%, after the implementation of a revised triage rule. After adjustment, revised paediatric triage rules decreased undertriage, OR = 0.5; 95% CI: 0.3-0.9; P < 0.02. The multivariate regression model identified the following risk factors of undertriage: children >10 years, two-wheel vehicle road traffic accident, girls after a fall, for boys after a winter ski accident, and infants with severe limb and pelvic injuries.
Conclusion:
The implementation of regional revised triage rule contributed to a reduction in the paediatric undertriage rate to 9%; several clinical factors were associated with undertriage.
