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Evidence-based Trauma Team Activation Criteria Combined with Physician Discretion Improves Over and Under-Triage Rates
Kathryn Mulligan, MS, Suzanne Moody, MPA, CCRP, Lynn Haas, RN, MSN, CNP, Richard A. Falcone, Jr., MD, MPH. Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA.

Tiered trauma-triage systems have been adopted to help match resources and needs of trauma patients. In 2010, a multi-center study identified eight evidence based highest level activation criteria. This study examines the effectiveness of these criteria at a Level I pediatric trauma center. A retrospective chart review was completed to compare over and under-triage rates before and after implementation. Over-triage was defined as meeting an activation criterion without utilization of a high level resource, while under-triage was inversely defined as lacking any activation criteria with subsequent resource utilization. A total of 510 charts were reviewed (235 pre-implementation and 275 post-implementation). In practice, our over-triage rate remained unchanged (43% vs. 42%) while our under-triage rate decreased (11% vs. 5%). If, however, the criteria were utilized independent of provider discretion, over-triage would have risen to over 60% with under-triage reaching 7%. If triage decisions were based solely on pre-hospital information, under-triage rate following implementation would have been 13% with an over-triage rate of 38%. Further analysis revealed a higher likelihood of resource utilization with increased number of activation criteria met (7% for 1 criteria; 89% for greater than 5 criteria). Implementation of evidence-based activation criteria, along with provider discretion, reduced under-triage to 5% without changing over-triage. Strict adherence to criteria without critical analysis would have resulted in significantly increased over-triage rates. Improved understanding of the interactions among individual activation criteria could lead to further improvement in appropriately predicting pediatric trauma patients likely to require high level resources.


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