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An analysis of pediatric trauma center undertriage in a mature trauma system

Rogers, Amelia T. MD; Horst, Michael A. PhD; Vernon, Tawnya M. BA; Gaines, Barbara A. MD; Bradburn, Eric H. DO, MS; Cook, Alan D. MD; Jammula, Shreya BS; Rogers, Frederick B. MD, MS, MA

Journal of Trauma and Acute Care Surgery: October 2019 - Volume 87 - Issue 4 - p 800–807
doi: 10.1097/TA.0000000000002265
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BACKGROUND Improved mortality as a result of appropriate triage has been well established in adult trauma and may be generalizable to the pediatric trauma population as well. We sought to determine the overall undertriage rate (UTR) in the pediatric trauma population within Pennsylvania (PA). We hypothesized that a significant portion of pediatric trauma population would be undertriaged.

METHODS All pediatric (age younger than 15) admissions meeting trauma criteria (International Classification of Diseases, Ninth Revision: 800–959) from 2003 to 2015 were extracted from the Pennsylvania Health Care Cost Containment Council (PHC4) database and the Pennsylvania Trauma Systems Foundation (PTSF) registry. Undertriage was defined as patients not admitted to PTSF-verified pediatric trauma centers (n = 6). The PHC4 contains inpatient admissions within PA, while PTSF only reports admissions to PA trauma centers. ArcGIS Desktop was used for geospatial mapping of undertriage.

RESULTS A total of 37,607 cases in PTSF and 63,954 cases in PHC4 met criteria, suggesting UTR of 45.8% across PA. Geospatial mapping reveals significant clusters of undertriage regions with high UTR in the eastern half of the state compared to low UTR in the western half. High UTR seems to be centered around nonpediatric facilities. The UTR for patients with a probability of death 1% or less was 39.2%.

CONCLUSION Undertriage is clustered in eastern PA, with most areas of high undertriage located around existing trauma centers in high-density population areas. This pattern may suggest pediatric undertriage is related to a system issue as opposed to inadequate access.

LEVEL OF EVIDENCE Retrospective study, without negative criteria, Level III.

From the General Surgery Residency, University of Louisville, Louisville, Kentucky (A.T.R.); Trauma and Acute Care Surgery, Penn Medicine Lancaster General Health, Lancaster, Pennsylvania (M.A.H., T.M.V., E.H.B., S.J., F.B.R.); and Department of Surgery (B.A.G.), UPMC Children's Hospital of Pittsburg, Pittsburg, Pennsylvania, Trauma Research Program (A.D.C.), Chandler Regional Medical Center, Chandler, Arizona.

Submitted: February 19, 2019, Accepted: March 5, 2019, Published online: March 15, 2019.

Address for reprints: Frederick B. Rogers, MD, MS, MA, FACS, 555 N Duke St, Lancaster, PA, USA 17602; email:

Online date: March 18, 2019

© 2019 Lippincott Williams & Wilkins, Inc.