Secondary Overtriage in a Pediatric Level One Trauma Center
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In brief
In brief
Retrospective study of 1,789 trauma activations finds 43.7% of transferred patients met criteria for secondary overtriage—unnecessary transfer to a level one pediatric trauma center despite minimal injuries. These overtriaged patients had higher admission rates and longer stays than similar patients transported directly from scene, representing significant resource burden that could be reduced through improved transfer criteria.
Written by the GCMD Library team from the article.
Abstract
Background
Previous studies have explored under- and overtriage, and the means by which to optimize these rates. Few have examined secondary overtriage (SO), or the unnecessary transfer of minimally injured patients to higher level trauma centers. We sought to determine the incidence and impact of SO in our pediatric level one trauma center.
Methods
We performed a retrospective analysis of all trauma activations at our institution from 2015 through 2017. SO was defined as transferred patients who required neither PICU admission nor an operation, with ISS ≤ 9 and LOS ≤ 24 hours. We compared SO patients against all trauma activation transfers, and against similar non-transferred patients.
Results
We identified 1,789 trauma activations, including 766 (42.8%) transfers. Of the transfers, 335 (43.7%) met criteria for SO. Compared to other transfers, SO patients had a shorter mean travel distance (52.9 v 58.1 mi; p = 0.02). Compared to similar patients transported from the trauma scene, SO patients were more likely to be admitted (52.2% v 29.2%; p < 0.001), with longer inpatient stay and greater hospital charges.
Conclusions
SO represents an underrecognized burden to trauma centers which could be minimized to improve resource allocation. Future research should evaluate trauma activation criteria for transferred pediatric patients.