Improving pediatric undertriage in a regional trauma network- a registry cohort study

Abstract

Background: Trauma remains an important cause of pediatric death worldwide. Management in dedicated pediatric trauma centers is beneficial making accurate prehospital triage crucial. We assessed the comprehensive undertriage in a regional trauma system after introduction of a revised pediatric triage rule. Methods: This retrospective, multicenter registry study included all pediatric trauma patients < 15 years admitted to Northern French Alps regional hospitals with suspicion of major trauma and/or an Abbreviated Injury Scale ≥3. Triage was assessed before and after introduction of a revised pediatric triage rule; performance was assessed by undertriage, overtriage, sensibility, specificity and likelihood ratios. A multivariable logistic regression identified predictors for undertriage. Undertriage was defined as a child with major trauma (presenting in need for trauma intervention) not directly transported to the pediatric trauma center. Results: All 1524 pediatric trauma cases from January 2009 to December 2020 were included. Among these, 725/1524 (47.6%) presented with major trauma; 593/1524 (38.9%) were referred to a non-pediatric trauma center, and 220/1524 (15%) were considered undertriaged.over the years, undertriage decreased from 15 to 9%, after introduction of a revised triage rule. The risk of undertriage increased for children > 10 years (OR 2.4; CI 95%: 1.1-5.6; P = 0.03), after a two wheel vehicle road traffic accident (OR 1.7; 95% CI: 1.1-2.7; P =0.03), for girls after a fall (OR 2.4; 95% CI: 1.3-4.7; P <0.01), for boys in winter ski accident (OR 3.0; 95% IC (1.4-6.5); P < 0.01), and for infants with severe limb and pelvic injury (OR 1.6; 95% IC (1.0-2.5); P = 0.04). Revised pediatric triage rules and helicopter transportation were associated with a reduction of undertriage, respectively with OR 0.5; CI 95%: 0.3-0.9; P< 0.02 and OR 0.4; CI 95%: 0.3-0.6; P < 0.01. Conclusion: The regional pediatric undertriage rate decreased to 9% after introduction of a revised triage rule; several clinical factors were associated with undertriage.