Standardized Trauma Team Activation Criteria Safely Triage Pediatric Trauma Patients within the National Trauma Data Bank(NTDB) from 2012-2014
*ibrahim Abd el-shafy1, Lisa Rosen2, Nelson Rosen1, *Francesca Bullaro1, *Nathan A.M. Christopherson3, *Jose M. Prince1
1Cohen Children's Medical Center, New Hyde Park, NY;2Feinstein Institute for Medical Research, Manhasset, NY;3Trauma Institute, Northwell Health System, Manhasset, NY
Background (issue): Currently no national standard for activation criteria exists resulting in individual trauma centers establishing their own tiered activation levels. Activation criteria are routinely evaluated for resource utilization using the Cribari-Matrix. We hypothesize that standardized national criteria for trauma team activation will result in accurate and safe pediatric patient triage, while optimally matching resources to patient need.
Methods: We applied a 3-tiered activation criteria for trauma team response from an ACS verified level1 pediatric trauma center to the 2012-2014-NTDB data. Cribari-Matrix analysis was performed using activation level and Injury Severity Score(ISS) to identify overtriage/undertriage rates. Statistical analyses were performed using SAS 9.4(SAS Institute, Cary, NC).
Findings: From 2012-2014 there was a total of 278,840 pediatric traumas identified, 15,901 were excluded due to a missing ISS. Upon application of our triage criteria, 42.39% met level 1, 10% level 2 and 47% met neither. Defining minor trauma <15, 59.24% were appropriately triaged, 34.78% overtriaged, and 5.98% undertriaged. Level 1 activation classification had a higher mortality rate(0.31%) compared to level 2(0.0013%)(p < 0.0001). Overtriaged had a higher mortality rate(0.13%) compared to those that were undertriaged(0.00%)(p < 0.0001). Acceptable results were seen when using ISS of 22 and 25 as the cut-off for severe trauma, with no mortalities in those undertirage.
Conclusions (implications for practice): Application of an institutional 3-tiered activation criteria retrospectively to the NTDB demonstrates acceptable over and undertriage rates. Importantly, no mortalities were seen in the undertriage group. Nationally standardized activation criteria may be beneficial in accurately and safely triaging pediatric trauma patients to match resource utilization.
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