Under-Triage of Pediatric Agricultural Trauma: A 23-Year Rural Cohort Analysis

Pediatric agricultural injuries pose a significant challenge to trauma systems, particularly in settings where pediatric trauma expertise is limited. Under triage, failure to activate an appropriate trauma or medical response can delay escalation of care and adversely affect outcomes. Existing triage algorithms may not fully account for the injury patterns and physiologic presentation of pediatric farm-related trauma.

To evaluate the prevalence of under triage and associated clinical outcomes among pediatric agricultural trauma patients using the Cribari Matrix Method (CMM) and the Need for Trauma Intervention (NFTI) algorithm.

This retrospective cohort study examined 133 pediatric agricultural trauma patients admitted to a Level II pediatric trauma center between 2000 and 2023. Under triage was defined by CMM or NFTI criteria. Outcomes included injury severity, ICU admission, hospital length of stay, discharge disposition, and in-hospital mortality. Comparisons were performed using the Wilcoxon rank-sum and chi-square tests.

Under triage occurred in 18% of cases. Under-triaged patients were younger (median 5.3 vs. 7.5 years) and had higher injury severity scores (median ISS 17 vs. 9; P<0.01), with more severe head (AIS 3.8 vs. 2.1) and abdominal injuries (AIS 3.2 vs. 1.5). Under-triaged patients were more often admitted directly to the ICU. Mortality among cases presenting to the trauma center was 3.7%.

A clinically meaningful proportion of pediatric agricultural trauma patients were under-triaged despite substantial injury severity. These findings highlight a discordance between injury burden and initial triage classification and underscore the need for triage protocols that adequately address pediatric farm-related injuries.