Sources of Over- and Undertriage at a Level I Pediatric Trauma Center Based on Mode of Arrival
Abigail E. Martin, MD MALS FAAP1; Donna Matwiejewicz, MSN, RN2; Thomas Pearson, MSN RN1; Sean Elwell, MSN RN NE-BC TCRN EMT1; Stephen G. Murphy, MD2
1Nemours/A.I. duPont Hospital for Children, Wilmington, DE; 2Nemours, Wilmington, DE
Background: The American College of Surgeons Committee on Trauma recommends that trauma centers strive for trauma team activation overtriage rates of 25-35% and undertriage rates of <5%. In order to better understand potential sources for both overtriage and undertriage at our trauma center, we investigated whether these rates differed depending on the method of arrival of patients to our emergency department.
Methods: We retrospectively reviewed all trauma patients evaluated in our Level I Pediatric Trauma Center from 1/1/12 through 12/31/17. We divided patients into three groups based on how they arrived to our ED: via private transport, via emergency medical services, or through transfer from another institution. We calculated overtriage and undertriage rates for each group using Cribari grids. Rates were compared using two-sample T test.
Results: Our trauma registry identified 3186 patients for this time period. The rates of overtriage and undertriage are presented below.
Conclusion: Our experience highlights several opportunities to improve accuracy in trauma team activation. Higher overtriage rates by EMS personnel may suggest unfamiliarity with pediatric patients or utilization of obsolete field triage criteria, while higher undertriage rates for transferred patients may indicate failure to recognize injuries by outside institutions prior to transfer. Protocols that provide for input from our pediatric staff when determining level of trauma team activation, rather than solely relying on outside personnel assessment, may improve accuracy.
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