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Immature Patients in a Mature System: Regional Analysis of Pediatric Trauma Triage Patterns and Resource Use in Florida
Christopher W. Snyder, MD1,2, Nicole M. Chandler, MD2, Paul D. Danielson, MD2, Cristen N. Litz, MD2, Etienne E. Pracht, PhD3, David J. Ciesla, MD1. 1University of South Florida Morsani College of Medicine, Tampa, FL, USA, 2Johns Hopkins All Children's Hospital, Petersburg, FL, USA, 3University of South Florida College of Public Health, Tampa, FL, USA.

Background: Florida's trauma centers seek to provide people of all ages with uniform access to trauma care, but regional triage and transfer patterns for injured children are unclear.

Methods: Using the Florida Agency for Health Care Administration database, we identified all trauma patients ≤ 15 years old admitted from 2009-2014. High risk patients (ICISS <0.85) receiving definitive treatment at a non-pediatric trauma center (PTC) were considered undertriaged; whereas low risk patients (ICISS ≥ 0.85) receiving definitive care at a PTC were considered overtriaged. Regions were compared with respect to triage patterns and likelihood of receiving definitive care within the same region. Regression models were used to adjust for covariates.

Results: Of 38,241 patients, 64% were definitively treated at PTCs and 8% were high risk. Rates of undertriage, overtriage, and out-of-region treatment varied significantly by region. The highest rates of undertriage (4.7%) and out-of-region treatment (52%) were seen in regions that lacked a PTC. Outcomes were similar across all regions. Patients requiring out-of-region treatment had higher hospital charges and slightly longer length of stay.

Conclusions: Significant regional variation exists in Florida with respect to pediatric trauma triage patterns and resource use, suggesting opportunities for further study and system optimization.

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