Under-triage of Severe Traumatic Brain Injury Results in Increased Mortality
Paul T Kim1, Juan P Gurria2, *Lynn Haas2, Mohammad Alfrad Nobel Bhuiyan2, Monir Hossain2, Misty Troutt2, *Suzanne Moody2, *Richard A Falcone, Jr.2
1University of Cincinnati, Cincinnati, OH;2Cincinnati Children's Hosptial Medical Center, Cincinnati, OH
Background: Timely triage of children with moderate to severe traumatic brain injuries (TBI) is important in optimizing outcomes. The overall under-triage rate of pediatric trauma patients in Ohio has been determined to be 54%. This study was designed to specifically exam under-triage of children with moderate or severe TBI and to exam the impact on mortality. Methods: The Ohio Trauma Registry was queried from 2007-2012, resulting in 14,045 children < 16 years admitted to a hospital for > 48 hours or who sustained traumatic death. Patients with an abbreviated injury scale greater than 2 in the head region were reviewed. Under-triage was defined as a combination of not being directly transferred to a pediatric trauma center when one was available within 30 minutes or not transferred within 2 hours of injury.Results: There were total of 2,453 patients (19/100,000 per year) with moderate/severe TBI. The overall under-triage rate was 24%, varying from 0-92.6% across state regions. Difference in under-triage rates between moderate versus severe TBI was significant (31.6% vs 17.2%; p=0.001). Overall, there were 156 deaths (6%; 1.2/100,000 per year). The mortality rate by region ranged from 0-9.2%. Under-triaged patients with TBI had a significantly higher mortality rate (10.7% vs 6.3%; p=0.0375).Conclusion: Although moderate/severe TBI patients have a lower under-triage rate compared to the overall trauma population, the rate remains higher than the goal of 5%. In addition, among those with TBI, under-triage results in a significantly higher mortality rate. Future efforts must focus on reducing the under-triage of severe pediatric TBI in order to improve outcomes across the state.
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