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Establishing a Standardized Trauma Team Activation Criteria Using the National Trauma Data Bank(NTDB)
Ibrahim Abd el-shaf, MD, Lisa Rosen, Francesca M. Bullaro, MD, Nathan A.M. Christopherson, MBA, Josť M. Prince, MD. Cohen Children's Medical Center, Northwell Health, New Hyde Park, New York, USA.

Background: In an effort to identify the correct resources required while minimizing cost, prior to patient arrival, trauma centers use activation levels. Currently no national standard for activation criteria exists. Activation criteria are routinely evaluated using a variety of methods, most commonly the Cribari-Matrix. We hypothesized that implementation of trauma tier activation criteria based on a combination of physiologic, anatomic and mechanism of injury parameters would be able to optimally triage pediatric trauma patients.

Methods: We implemented a 3-tiered activation criteria for trauma team response at an ACS verified level1 pediatric trauma center. Each level corresponds to a predetermined set of team members and resource mobilization. Using descriptive statistical analysis our criteria was applied to the 2012-NTDB. Analysis was conducted with the Cribari-Matrix using activation level and Injury Severity Score(ISS) to identify overtriage/undertriage rates. We then identified the components and leading causes of overtirage.

Results: When applied to the NTDB(n=95,319), our activation criteria yielded overtriage/undertriage rates of 65.62%/2.83% respectively. Among those incidents mis-triaged(n=32,790), overtriaged had a higher mortality rate(0.39%) as compared to those undertriaged(0.00%)(P<0.0210). The majority of our level1 overtriage(90.81%) was due to severe respiratory compromise while level2 overtriage was due to long bone injury(22.54%).

Conclusions: When applying trauma triage criteria consisting of physiologic, anatomic and mechanism of injury parameters to the NTDB there was a significant rate of overtriage. Given the airway concerns in a pediatric population for pre-hospital providers, overtriage due to these criteria may be deemed acceptable. Comparison of NTDB to institutional data may allow for more detailed future analysis of triage data.

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