Optimizing Trauma Center Resources: Tiered Pediatric Trauma Team Activation Process
Stephanie DeMoor, BS1; Michael Shiels, RN, BSN2; Susannah E. Nicholson, MD1; Mark Muir, MD1; Jenny Oliver, RN, BSN2; Sondra Epley, RN3; Colleen Davis, RN, BSN2; Lillian F. Liao, MD1
1University of Texas Health San Antonio, San Antonio, TX; 2University Health Systems, San Antonio, TX; 3University Health System, San Antonio, TX
Background: Optimal utilization of trauma center resources is an integral part of a trauma program. Field triage of children is challenging. Thus, refinement of the triage criteria must be ongoing in order to balance resource utilization with optimal care of injured children.
Methods: Pediatric trauma triage criteria at a Level I Trauma Center were updated in July 2017. All patients seen from July to December 2017 were reviewed.
Results: Over a six-month period, 952 pediatric trauma patients were found in the trauma registry, 792 patients had complete registry information. There were 80 Level I-Alpha activations, 97 Level 1 activations, and 615 Level II activations. 24% of the patients with Level I-Alpha activations were admitted to the ICU compared to 10% of Level I and 9% Level II activations. Similarly, a higher percentage of patients in the Level I-Alpha group went to the operating room [25% vs. 15% vs. 6%; I-Alpha vs. I vs. II]. Conversely, patients in the Level II activation were more likely to be discharged home from the emergency room [20% vs. 20% vs. 51%; I-Alpha vs. I vs. II]. In this time period, undertriage increased from 2.8% to 3.5% while overtriage decreased from 85% to 76% .
Conclusions: Evaluation of the tiered pediatric trauma team activation shows that limiting the highest-level activation to the most severely injured will optimize hospital resource utilization. Due to the low number of severely injured children at any one center, multi-center collaborations to review the triage process would be beneficial.
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