Effect of under triage on early mortality after major pediatric trauma: a registry-based propensity score matching analysis

François-Xavier Ageron,Jordan Porteaud,Jean-Noël Evain,Albrice Levrat,Anne Millet,Guillaume Mortamet,Cécile Vallot,Pierre Bouzat,Jules Greze

doi:10.1186/s13017-020-00345-w

Abstract

BackgroundLittle is known about the effect of under triage on early mortality in trauma in a pediatric population. Our objective is to describe the effect of under triage on 24-h mortality after major pediatric trauma in a regional trauma system.MethodsThis cohort study was conducted from January 2009 to December 2017. Data were obtained from the registry of the Northern French Alps Trauma System. The network guidelines triage pediatric trauma patients according to an algorithm shared with adult patients. Under triage was defined by the number of pediatric trauma patients that required specialized trauma care transported to a non-level I pediatric trauma center on the total number of injured patients with critical resource use. The effect of under triage on 24-h mortality was assessed with inverse probability treatment weighting (IPTW) and a propensity score (Ps) matching analysis.ResultsA total of 1143 pediatric patients were included (mean [SD], age 10 [5] years), mainly after a blunt trauma (1130 [99%]). Of the children, 402 (35%) had an ISS higher than 15 and 547 (48%) required specialized trauma care. Nineteen (1.7%) patients died within 24 h. Under triage rate was 33% based on the need of specialized trauma care. Under triage of children requiring specialized trauma care increased the risk of death in IPTW (risk difference 6.0 [95% CI 1.3–10.7]) and Ps matching analyses (risk difference 3.1 [95% CI 0.8–5.4]).ConclusionsIn a regional inclusive trauma system, under triage increased the risk of early death after pediatric major trauma.

Highlights

Little is known about the effect of under triage on early mortality in trauma in a pediatric population
Between 2009 and 2017, 1180 consecutive pediatric patients were admitted in the TRENAU network with a suspicion of severe trauma
Four children died on scene and 33 were managed by a prehospital team outside the TRENAU network

Summary

Introduction

Little is known about the effect of under triage on early mortality in trauma in a pediatric population. Our objective is to describe the effect of under triage on 24-h mortality after major pediatric trauma in a regional trauma system. The implementation of trauma systems has been advocated worldwide to reduce mortality after severe trauma [1] These systems rely on designated trauma centers and standardized field triage to provide appropriate care. Most triage protocols were adapted from adult algorithms in countries where prehospital care is performed by paramedics [8]. The Northern French Alps trauma system (TREN AU) is an inclusive regional trauma system implemented in the French Alps with a physician-staffed field triage procedure combining a grading system with an algorithm for triage [11]. The main objective of the study was to assess the effect of under triage on early mortality in a pediatric trauma population

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