H. Naseem2, N. Pantano1, K. D. Bass1,2 1State University Of New York At Buffalo,College Of Medicine,Buffalo, NY, USA 2Women And Children’s Hospital Of Buffalo,Department Of Pediatric Surgery,Buffalo, NY, USA
Introduction: The American College of Surgeons (ACS) has described criteria for highest-level (Level I) trauma team activation (TTA) and presented guidelines for limited trauma team activation (Level II) and trauma consults. Evidence based literature is lacking on data supporting Level II activation and consult guidelines for pediatric trauma patients. At our center, the current criteria for Level II TTA leads to a high rate of overtriage, especially with a large percentage of ‘motor vehicle crashes (MVC) greater than 20 mph’ and ‘pedestrian or bike versus vehicle’ being discharged from the emergency department (ED). This study was designed to evaluate possible options to optimize surgeons as resources by revising our current Level II activation criteria. We hypothesized that allowing ED to evaluate ‘MVC>20mph’ and ‘pedestrian or bike versus vehicle’ prior to the Level II activation would significantly reduce the overtriage rate while maintaining an acceptable undertriage rate.
Methods: Trauma registry data was reviewed for a five-month period. Overtriage was defined as Level I and II TTAs that were discharged from the ED. Undertriage was defined as trauma consults that were admitted to the intensive care unit or had an injury severity score (ISS) greater than 16. The over and undertriage rates were calculated using the matrix method defined by ACS. The two most common criteria resulting in overtriage were then identified, and the over and undertriage rates were recalculated with these criteria moved to the consult category. Charts were reviewed to verify that there were no missed injuries or diagnosis. Over and undertriage rates before and after criteria revision were statistically analyzed using the paired t-test.
Results: The over and undertriage rates using current criteria were 54.0% and 2.1%, respectively. The two criteria leading to the most overtriage were ‘MVC>20mph’ and ‘pedestrian or bike versus vehicle’. When the rates were recalculated moving these two criteria under the consult category, the overtriage rate was 37.3% (p <0.001) and the undertriage rate was 2.7% (p 0.16). After chart review no missed injuries or diagnosis were identified.
Conclusion: The overtriage rate and use of surgeons as resources in trauma activations may be reduced by allowing the ED to evaluate ‘MVC>20mph’ and ‘pedestrian or bike versus vehicle’ prior to Level II activation, eliminating surgeon response for non-injured children. The protocol will be changed and the data will be prospectively collected and analyzed for follow-up to confirm that the overtriage and undertriage rates continue to meet the expected rates.
