Effect of under triage on early mortality after major pediatric trauma: a registry-based propensity score matching analysis

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.

Air Rescue for Pediatric Trauma in a Metropolitan Region of Brazil: Profiles, Outcomes, and Overtriage Rates

“…Our analysis focused on the indications based on anatomical injuries and physiological changes. Unlike what has been described in international studies ( 4 – 6 , 10 , 21 ), most children who had severe trauma in our data presented an ISS ≥25. Our finding is significant since ISS is the main score used to characterize overtriage in trauma in the literature.…”

“…Our finding is significant since ISS is the main score used to characterize overtriage in trauma in the literature. However, some authors also associate the overtriage criteria with the need for early critical resources (such as ICU admission, non-orthopedic surgery, or transfusion) not relying on the ISS classification alone ( 21 , 22 ). Defined as the screening decision that results in unnecessary use of resources or personnel ( 10 ), overtriage is common in aeromedical rescues ( 6 ) since different protocols and perceptions of severity by the crew can lead to subjectivity in the victims' assessment.…”

“…Defined as the screening decision that results in unnecessary use of resources or personnel ( 10 ), overtriage is common in aeromedical rescues ( 6 ) since different protocols and perceptions of severity by the crew can lead to subjectivity in the victims' assessment. In addition, first responders must also take care in avoiding undertriage, underestimating the urgency of the patient's condition, and perhaps erroneously saving resources or not transferring the patient to a trauma center, leading to a significant increase in mortality ( 7 , 21 ).…”

“…However, it has the disadvantage of being calculated based on diagnoses during hospitalization, thus not applicable for screening at the scene. Prehospital assessment of severity in pediatric trauma cases can be challenging due to the child's anatomy and physiology ( 21 , 25 , 26 ). The sensitivity of pediatric prehospital triage tools ranging has been reported to range from 49.1% to 87.3% ( 21 ), sometimes resulting in overtriage rates higher than 20% ( 22 ).…”

COVID‐19 response by New Zealand general surgical departments in tertiary metropolitan hospitals

“…All three guidelines recommended testing all patients pre‐operatively. 8 , 10 , 11 However, in our centres, all patients were screened for COVID‐19 symptoms and had epidemiological risks examined. Only individuals with a significant pre‐test probability of having COVID‐19 were tested.…”