C. G. Dessaigne1, K. J. Caldwell1, S. D. Larson1, J. A. Taylor1, D. W. Kays1, S. Islam1 1University Of Florida,Gainesville, FL, USA
Introduction: Trauma centers and the triage or ‘alert’ system has been shown to save lives. There remain issues with both over and under triage however, and that may result in significant expense to the hospital, or potentially increased morbidity to the patient. The purpose of this study was to compare the presentation and outcomes in children with trauma that presented after an alert or not.
Methods: IRB approval was obtained and data collected for a retrospective cohort analysis of all pediatric trauma patients (less than 16 years of age) between May 2010 and August 2013. Data regarding demographics, trauma details, ED and hospital course, and outcomes were collected. Patients were in either the ‘alerted’ or ‘non alerted’ groups, and an age and ISS matched cohort was selected for comparison.
Results: We found 359 ‘alerted’ and 1004 ‘non-alerted’ patients during the study period. Overall, the mean ISS, median GCS was higher in the ‘alerts’. After selecting an age and ISS matched cohort of ‘non alerts’, we performed Univariate analyses. Physiologic parameters of heart rate and systolic/diastolic BP, and respiratory rate were statistically higher in the alerted patients, but clinically not different. Median GCS was equivalent. The mortality rate was not different (3.6 vs. 1.6%), and there were no missed injuries in the non-alerted group. The ICU and overall hospital LOS was slightly greater in the alerted group, with an equivalent number of procedures and consults being done (table). In addition, we noted that 26% of the ‘alerts’ were based on the criteria of paramedic discretion. Separate analysis of this group noted that 62% were admitted to the floor, 6% were discharged home after being downgraded from an alert, and there was only one patient with a GCS less than 13. This reduced the discriminating power of a trauma 'alert'.
Conclusion: We noted a 25% rate of trauma alerts during the study period. The alerted patients presented with minimal physiologic change compared to the non alerts, and the outcomes were not significantly different including mortality. This suggests that the triage system may need to be adjusted. Education of paramedics would be helpful in reducing the number of unnecessary alerts and improve the cost efficiency of the system.
