Consequences of pediatric undertriage and overtriage in a statewide trauma system

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 health care 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 to 2013 among 45 hospitals in Utah's statewide trauma system.

RESULTS 

The odds of pediatric transfer were 13 times lower (odds ratio, 13.15; p < 0.0001; 95% confidence interval, 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 twice higher in undertriage hospitals than overtriage hospitals (OR, 2.44; p < 0.0001; 95% confidence interval, 1.5–3.8). Among pediatric patients that survived the injury to transfer, 61% were discharged from the pediatric center in < 24 hours.

CONCLUSION 

Substantial opportunity exists in the state trauma system to improve pediatric trauma patient transfer practices to reduce pediatric trauma mortality, morbidity, and health care costs associated with unnecessary transfers.

LEVEL OF EVIDENCE 

Prognostic and epidemiological, level III.