An Analysis of Pediatric Trauma Center Undertriage in a Mature Trauma System.

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 <15) admissions meeting trauma criteria (ICD-9: 800-959) from 2003-2015 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). 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: 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 appears to be centered around non-pediatric facilities. UTR for patients with a probability of death <1% 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 evidenceIII.