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Variation of Highest Level Pediatric Trauma Activation Criteria Across the United States
Rita V. Burke, PhD, MPH1,2, Jessica Zagory, MD1, Minna Wieckh, MD1, E. Brooke Lerner, PhD3, Suzanne Moody, MPA, CCRP4 and Richard A. Falcone, MD, MPH4; 1Children's Hospital Los Angeles, Los Angeles CA; 2University of Southern California, Los Angeles CA; 3Medical College of Wisconsin, Milwaukee WI; 4Cincinnati Children's Hospital Medical Center, Cincinnati OH

Abstract:
PURPOSE In 2002, the American College of Surgeons (ACS) mandated six criteria for highest level trauma activation. It is thought that Pediatric trauma centers have modified these criteria which could lead to inconsistency. The purpose of this study was to assess the variability in the highest level activation criteria used by pediatric trauma centers across the United States. METHODS In collaboration with the American College of Surgeons (ACS), we obtained the activation criteria for highest level trauma activation utilized by ACS-verified level 1 pediatric trauma centers across the United States. Two reviewers categorized each criteria. This was then used to determine the degree of variation that exists among pediatric trauma centers. RESULTS Highest level activation criteria were obtained from 56 ACS- verified level 1 pediatric trauma centers. The activation indicators were grouped into the following categories: patient demographics, physiologic signs, anatomic findings, intervention/resource utilization, mechanism and other (e.g., ED/trauma physician discretion or transfer). There were a total of 69 different criteria. Number of criteria per center ranged from 5-30. The anatomic category had the most criteria with 22 indicators. The most common criteria added to the ACS-6 was ED or trauma surgeon discretion (63%), amputation or crush injury proximal to wrist/ankle (61%) and spinal cord injury or paralysis (61%). CONCLUSION There is wide variation in highest level trauma activation criteria among level 1 pediatric trauma centers. Further research is needed to define an evidence-based group of activation criteria.
Objective:
1. To discuss the variability highest level trauma activation criteria among US pediatric trauma center.
Objective Content: 1. Discuss the evidence for pre-hospital endotracheal intubation for pediatric trauma. 2. Identify risk factors associated with pre-hospital endotracheal intubation stratified by location of intubation (referring, non-level-1 trauma center versus scene intubation by first responders). 3. Compare outcomes for a large retrospective study comparing pre-hospital intubation settings 4. Discuss recommendations for pre-hospital protocols for air way management in pediatric trauma.


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