343EMF Primary Triage Patterns of Seriously Injured Children in California (2005-2013)

Abstract

Trauma centers (TC) are demonstrated to save lives. However, TC and especially pediatric trauma centers (pTC) are scarce and concentrated in urban areas. A population-level understanding of where injured children are initially cared for (primary triage) is incomplete. We determine patient and regional factors associated with primary triage location. Retrospective cohort study of California Office of Statewide Health Planning and Development (OSHPD) linked emergency department and inpatient discharge data (2005-2013). California residents 0-17 years admitted with serious trauma diagnoses (injury severity score (ISS) >9) were included. Hospitals were categorized as: pTC, adult level I/II TC (aTC), level III/IV TC, pediatric non-trauma center (pediatric nTC), and adult non-TC (nTC). Using multivariable, multivariate logistic regression, we calculated predicted probabilities of primary triage to pTC, aTC and nTC, evaluating age, sex, race/ethnicity, payer, ISS, injury mechanism, intention, type, zip-code level poverty, urban/rural status, and presence of a TC in county of residence. During the study period, 25,312 children were admitted for serious injury. Primary triage to a pTC, aTC, level III/IV, pediatric nTC, and nTC occurred 37%, 36%, 2% 3%, and 22% of the time respectively. The median age of children triaged to a pTC, aTC, level III/IV, pediatric nTC, and nTC was 9 (IQR 3-14), 15 (11-17), 14 (7-16), 4 (0-12), and 13 (5-16) years. The median ISS of children in all hospital types was 16 (IQR 11-17). Half of children <14 years were triaged to pTC compared to aTC and nTC (52% vs. 22%, 26%). Conversely, half of children 14-17 were triaged to aTC compared to pTC or nTC (54%, vs. 20%, 26%). Children with public insurance were twice as likely to be triaged to pTC and aTC compared to nTC (40%, 38% vs. 22%); those with private non-HMO insurance were approximately 10% more likely to be triaged to pTC and aTC compared to nTC (36% and 37% vs. 27%); those with private HMO insurance were less likely to be triaged to pTC and aTC compared to nTC, (19%, 27% vs. 55%). Children in motor vehicle collisions (MVC) were twice as likely to be triaged to pTC and aTC compared to nTC (39%, 44% vs. 17%). Children with assault were more likely to be triaged to pTC and aTC compared to nTC (33%, 40% vs. 27%). Children living in counties with a TC were more likely to be triaged to pTC than aTC and nTC (61% vs. 19%, 20%). Children from micropolitan areas were more likely to be triaged to pTC compared to aTC and nTC (51% vs. 12%, 37%), and those with zip-code median household income below 200% FPL were 10% more likely to be triaged to a pTC and aTC compared to nTC (36%, 37% vs. 27%). Our population perspective of primary triage location for California children with serious injuries demonstrates that triage location is associated with age, payer, mechanism of injury, and intent. Regional variables demonstrate that children in rural areas are regionalized to pediatric trauma care.View Large Image Figure ViewerDownload Hi-res image Download (PPT)