François-Xavier Ageron1, Jordan Porteaud2, Jean-Noël Evain2, Anne Millet3, Jules Greze2, Cécile Vallot1, Albrice Levrat4, Guillaume Mortamet3,5, Pierre Bouzat6,7,8. 1. RENAU Northern French Alps Emergency Network, Public Health Department, Annecy Hospital, F-74000, Annecy, France. 2. Grenoble Alps Trauma Center, Department of Anesthesiology and Intensive Care Medicine, Grenoble University Hospital, F-38000, Grenoble, France. 3. Department of Pediatric Care, Pediatric Intensive Care Unit, Grenoble University Hospital, F-38000, Grenoble, France. 4. Department of Intensive Care, Annecy Hospital, F-74000, Annecy, France. 5. Grenoble Alps University, F-38000, Grenoble, France. 6. Grenoble Alps Trauma Center, Department of Anesthesiology and Intensive Care Medicine, Grenoble University Hospital, F-38000, Grenoble, France. PBouzat@chu-grenoble.fr. 7. Grenoble Alps University, F-38000, Grenoble, France. PBouzat@chu-grenoble.fr. 8. Grenoble Alpes Trauma Centre, Pôle d'Anesthésie-Réanimation, Hôpital Albert Michallon, BP 217, F-38043, Grenoble, France. PBouzat@chu-grenoble.fr.
Abstract
BACKGROUND: Little is known about the effect of under triage on early mortality in trauma in a pediatric population. Our objective is to describe the effect of under triage on 24-h mortality after major pediatric trauma in a regional trauma system. METHODS: This cohort study was conducted from January 2009 to December 2017. Data were obtained from the registry of the Northern French Alps Trauma System. The network guidelines triage pediatric trauma patients according to an algorithm shared with adult patients. Under triage was defined by the number of pediatric trauma patients that required specialized trauma care transported to a non-level I pediatric trauma center on the total number of injured patients with critical resource use. The effect of under triage on 24-h mortality was assessed with inverse probability treatment weighting (IPTW) and a propensity score (Ps) matching analysis. RESULTS: A total of 1143 pediatric patients were included (mean [SD], age 10 [5] years), mainly after a blunt trauma (1130 [99%]). Of the children, 402 (35%) had an ISS higher than 15 and 547 (48%) required specialized trauma care. Nineteen (1.7%) patients died within 24 h. Under triage rate was 33% based on the need of specialized trauma care. Under triage of children requiring specialized trauma care increased the risk of death in IPTW (risk difference 6.0 [95% CI 1.3-10.7]) and Ps matching analyses (risk difference 3.1 [95% CI 0.8-5.4]). CONCLUSIONS: In a regional inclusive trauma system, under triage increased the risk of early death after pediatric major trauma.
BACKGROUND: Little is known about the effect of under triage on early mortality in trauma in a pediatric population. Our objective is to describe the effect of under triage on 24-h mortality after major pediatric trauma in a regional trauma system. METHODS: This cohort study was conducted from January 2009 to December 2017. Data were obtained from the registry of the Northern French Alps Trauma System. The network guidelines triage pediatric traumapatients according to an algorithm shared with adult patients. Under triage was defined by the number of pediatric traumapatients that required specialized trauma care transported to a non-level I pediatric trauma center on the total number of injured patients with critical resource use. The effect of under triage on 24-h mortality was assessed with inverse probability treatment weighting (IPTW) and a propensity score (Ps) matching analysis. RESULTS: A total of 1143 pediatric patients were included (mean [SD], age 10 [5] years), mainly after a blunt trauma (1130 [99%]). Of the children, 402 (35%) had an ISS higher than 15 and 547 (48%) required specialized trauma care. Nineteen (1.7%) patientsdied within 24 h. Under triage rate was 33% based on the need of specialized trauma care. Under triage of children requiring specialized trauma care increased the risk of death in IPTW (risk difference 6.0 [95% CI 1.3-10.7]) and Ps matching analyses (risk difference 3.1 [95% CI 0.8-5.4]). CONCLUSIONS: In a regional inclusive trauma system, under triage increased the risk of early death after pediatric major trauma.
Entities:
Keywords:
Major pediatric trauma; Mortality; Propensity score; Trauma system; Under triage
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