Citation

Hewes HA, Christensen M, Taillac PP, Mann NC, Jacobsen KK, Fenton SJ. J. Trauma Acute Care Surg. 2017; 83(4): 662-667.

Affiliation

1Division of Pediatric Emergency Medicine, University of Utah School of Medicine, 295 Chipeta Way, Salt Lake City, UT 84109, Hilary.hewes@hsc.utah.edu, kammyjacobsen@gmail.com 2Bureau of Emergency Medical Services and Preparedness, Utah Department of Health, 3760 S Highland Drive #4, Salt Lake City, UT 84106, Mathew.christensen@state.de.us 3Division of Emergency Medicine, University of Utah School of Medicine, 30 N 1900 E 1C026, Salt Lake City, UT 84132, Peter.taillac@hsc.utah.edu 4Department of Pediatrics, University of Utah School of Medicine, 295 Chipeta Way, Salt Lake City, UT 84109, clay.mann@utah.edu 5Division of Pediatric Surgery, University of Utah School of Medicine, 100 North Medical Drive, Suite 3800, Salt Lake City, UT 84113, Stephen.fenton@hsc.utah.edu.

Copyright

(Copyright © 2017, Lippincott Williams and Wilkins)

DOI

10.1097/TA.0000000000001560

PMID

28538650

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 healthcare 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 2001-2013 among 45 hospitals in Utah's statewide trauma system.

RESULTS: The odds of pediatric transfer were 13x lower (OR=13.15, P<.0001, 95% CI: 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 2x higher in undertriage hospitals than overtriage hospitals (OR=2.44, P<.0001, 95% CI: 1.5-3.8). Among pediatric patients that survived the injury to transfer, 61% were discharged from the pediatric center in < 24 hours.

CONCLUSIONS: Substantial opportunity exists in the state trauma system to improve pediatric trauma patient transfer practices to reduce pediatric trauma mortality, morbidity, and healthcare costs associated with unnecessary transfers. LEVEL OF EVIDENCE: III STUDY TYPE: Prognostic and Epidemiological.

Language: en