Hilary A Hewes1, Mathew Christensen, Peter P Taillac, N Clay Mann, Kammy K Jacobsen, Stephen J Fenton. 1. From the Division of Pediatric Emergency Medicine (H.A.H., K.K.J.), University of Utah School of Medicine, Salt Lake City, Utah; Bureau of Emergency Medical Services and Preparedness (M.C.), Utah Department of Health, Salt Lake City, Utah; Division of Emergency Medicine (P.P.T.), University of Utah School of Medicine, Salt Lake City, Utah; Department of Pediatrics (N.C.M.), University of Utah School of Medicine, Salt Lake City, Utah; and Division of Pediatric Surgery (S.J.F.), University of Utah School of Medicine, Salt Lake City, Utah.
Abstract
BACKGROUND: With increasing attention to the quality of health care delivery, evaluating trauma triage decisions in a large system of emergency care can help decision makers reduce mortality, morbidity, unnecessary transfers, and health care costs. OBJECTIVES: To quantify the magnitude of pediatric traumatic injury undertriage (hospital mortality risk) and overtriage (early trauma center discharge after transfer) in a statewide trauma system. METHODS: A statewide population-based evaluation of pediatric trauma outcomes and secondary triage (interfacility transfers) patterns from 2001 to 2013 among 45 hospitals in Utah's statewide trauma system. RESULTS: The odds of pediatric transfer were 13 times lower (odds ratio, 13.15; p < 0.0001; 95% confidence interval, 11.0-15.7) in acute care hospitals meeting undertriage criteria than hospitals meeting overtriage criteria. Hospital triage practice was a stronger predictor of pediatric transfer than injury severity, injury diagnoses, age, and geographic distance. The likelihood of pediatric trauma mortality was more than twice higher in undertriage hospitals than overtriage hospitals (OR, 2.44; p < 0.0001; 95% confidence interval, 1.5-3.8). Among pediatric patients that survived the injury to transfer, 61% were discharged from the pediatric center in < 24 hours. CONCLUSION: Substantial opportunity exists in the state trauma system to improve pediatric trauma patient transfer practices to reduce pediatric trauma mortality, morbidity, and health care costs associated with unnecessary transfers. LEVEL OF EVIDENCE: Prognostic and epidemiological, level III.
BACKGROUND: With increasing attention to the quality of health care delivery, evaluating trauma triage decisions in a large system of emergency care can help decision makers reduce mortality, morbidity, unnecessary transfers, and health care costs. OBJECTIVES: To quantify the magnitude of pediatric traumatic injury undertriage (hospital mortality risk) and overtriage (early trauma center discharge after transfer) in a statewide trauma system. METHODS: A statewide population-based evaluation of pediatric trauma outcomes and secondary triage (interfacility transfers) patterns from 2001 to 2013 among 45 hospitals in Utah's statewide trauma system. RESULTS: The odds of pediatric transfer were 13 times lower (odds ratio, 13.15; p < 0.0001; 95% confidence interval, 11.0-15.7) in acute care hospitals meeting undertriage criteria than hospitals meeting overtriage criteria. Hospital triage practice was a stronger predictor of pediatric transfer than injury severity, injury diagnoses, age, and geographic distance. The likelihood of pediatric trauma mortality was more than twice higher in undertriage hospitals than overtriage hospitals (OR, 2.44; p < 0.0001; 95% confidence interval, 1.5-3.8). Among pediatric patients that survived the injury to transfer, 61% were discharged from the pediatric center in < 24 hours. CONCLUSION: Substantial opportunity exists in the state trauma system to improve pediatric traumapatient transfer practices to reduce pediatric trauma mortality, morbidity, and health care costs associated with unnecessary transfers. LEVEL OF EVIDENCE: Prognostic and epidemiological, level III.
Authors: Craig D Newgard; Peter E Fischer; Mark Gestring; Holly N Michaels; Gregory J Jurkovich; E Brooke Lerner; Mary E Fallat; Theodore R Delbridge; Joshua B Brown; Eileen M Bulger Journal: J Trauma Acute Care Surg Date: 2022-04-27 Impact factor: 3.697