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Understanding State-wide Pediatric Under-Triage
Lynn Haas RN, MSN, Juan Gurria, MD, Mohammad Alfrad Nobel Bhuiyan, MD, Monir Hossain, PhD, Misty Troutt, MS, MBA, Suzanne Moody, MPA, CCRP, Richard A. Falcone, Jr., MD, MPH. Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA.

Background: Appropriate and timely triage is an essential component of a trauma system. In the state of Ohio there are 6 verified pediatric trauma centers (PTC) across 8 state regions. The purpose of this study was to better understand the pediatric under-triage rates in the state.

Methods: We utilized the Ohio Trauma Registry from 2007 2012, consisting of 14,045 records of children < 16 years admitted to a hospital for greater than 48 hours or who sustained a traumatic death. Pediatric under-triage was defined and a combination of not being directly transferred to a PTC when one was available with 30 minutes or not being transferred to a PTC within 2 hours of injury.

Results: The state pediatric under-triage rate was 54%, only decreasing to 38% when up to a four-hour transfer time was allowed. Across state trauma regions, under-triage rates varied from 94% to 40%. 35% of children never made it to a PTC and over 3% of children remained at a non-trauma center (NTC), with regional variation between from 5% to 0.5%. Statewide mortality was nearly 3% with regional variation between 5% to 0.4%.

Conclusions: In conclusion, despite the significant number of PTCs in Ohio, there remains a high under-triage rate with significant regional variations and long transfer times. Continued analysis will be useful in furthering trauma system development for the injured child.

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