Pediatric Trauma Undertriage: Working Toward a Better Threshold Based on Trauma Center Resource Utilization.

Area of Science:

• Trauma Surgery
• Pediatric Critical Care
• Health Services Research

Background:

• Pediatric trauma systems need accurate metrics to evaluate triage decisions and identify undertriage, where injured children don't receive appropriate care.
• Current undertriage definitions rely on mortality-based scores like Injury Severity Score (ISS) and ICD Injury Severity Score (ICISS).
• Resource-based metrics, such as the ICD Critical Care Severity Score (ICASS), may offer a more suitable approach for pediatric undertriage assessment.

Purpose of the Study:

• To evaluate the relationship between ISS, ICISS, and ICASS and the need for pediatric trauma resources (NFPTCR).
• To derive a more empiric definition of pediatric trauma undertriage using resource-based metrics.

Main Methods:

• Utilized the American College of Surgeons Trauma Quality Improvement Program database for patients aged 15 years or younger.
• Defined NFPTCR based on criteria including transfusion, invasive procedures, ICU admission/stay, ventilation, and physical child abuse.
• Assessed the discriminative ability of ISS, ICISS, and ICASS using multivariable logistic regression and ROC analysis.

Main Results:

• Out of 97,773 children, 16% required pediatric trauma resources (NFPTCR+).
• ICASS demonstrated superior performance (Area Under Curve: 0.812) compared to ISS (0.760) and ICISS (0.701) in identifying NFPTCR+ patients.
• ICASS achieved high sensitivity (95% at score 5, 93% at 10, 89% at 15) for identifying NFPTCR+, outperforming ISS.

Conclusions:

• The ICASS metric is more effective than ISS and ICISS in identifying children who need pediatric trauma resources.
• Redefining pediatric trauma undertriage based on resource-utilization metrics like ICASS should be considered.
• This approach may lead to more accurate identification and improved care for critically injured children.