Pediatric Trauma Specific Pre-hospital Triage and Inter-hospital Transfer Guidelines in the United States
Megan Foley, BA1; Lindsey Ferro, MD2; Jeffrey Haynes, MD3
1Virginia Commonwealth University School of Medicine, Richmond, VA; 2Virginia Commonwealth University Department of Surgery, Richmond, VA; 3Children's Hospital of Richmond, VCU, Richmond, VA
Background: Traumatic injury remains the leading cause of death in children; accordingly, there has been recent emphasis at the state level to designate pediatric trauma centers and to seek external validation through the American College of Surgeons (ACS). It follows that pediatric specific pre-hospital trauma triage and inter-hospital guidelines should exist to support these developing trauma systems; however, the existence and extent of such guidelines has not been documented.
Methods: State health departments and EMS administrations were queried about the existence and content of pediatric specific state trauma triage and transfer guidelines. The ACS provided the number and level of verified pediatric trauma centers by state.
Results: Response was obtained from 48/50 states (96%). 32/48 designate pediatric trauma centers (66%). Of the 32 state designated facilities, 8 (25%) had state triage and 8 (25%) had state transfer guidelines in place. Four states (12%) reported having both. The ACS has verified 96 Level 1 and 2 pediatric trauma centers in 36 states (72%). Of the states with reported triage or transfer guidelines, 50% contained an ACS verified pediatric trauma center. Review of the guidelines was without uniformity other than reference to CDC field triage criteria.
Conclusion: The existence and extent of state pediatric specific trauma triage and inter-hospital transfer guidelines is highly variable among states with designated or ACS verified pediatric trauma centers and overall represents a significant national deficit. Development of these guidelines is needed to improve use of developing state pediatric trauma systems.
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