Pediatric trauma under-triage in Ohio.

BACKGROUND: Appropriate and timely triage is an essential component of a trauma system. In the state of Ohio there are 6 verified pediatric trauma centers (PTC) across 8 state regions. The purpose of this study was to better understand the pediatric under-triage rates in the state.

METHODS: We utilized the Ohio Trauma Registry from 2007 - 2012, consisting of 14,045 records of children < 16 years admitted to a hospital for greater than 48 hours or who sustained a traumatic death. Pediatric under-triage was defined as a combination of not being directly transported to a PTC when one was available within 30 minutes or not being transferred to a PTC within 2 hours of injury.

RESULTS: The state pediatric under-triage rate was 52%, only decreasing to 35% when up to a four-hour transfer time was allowed. Across state trauma regions, under-triage rates varied from 94% to 40%. Over 28% of injured children had access to a PTC within 30 minutes of their home. A trauma center (adult or pediatric) was within 30 minutes for 66% of the children, yet 32% of the children went to a non-trauma center (NTC) first. Overall, 29% of children never made it to a PTC and 4% of children remained at a NTC, with regional variation between from 5% to 0.5%. Statewide mortality was nearly 3% with regional variations between 5% to 0.4%. Mortality within the appropriately triaged group was 5.3% while only 0.7% in the under-triage group. Overall 53% of transferred patients had a greater than 2 hour transfer time.

CONCLUSIONS: In conclusion, despite the significant number of PTCs in Ohio, there remains a high under-triage rate with significant regional variations and long transfer times. Continued analysis will be useful in furthering trauma system development for the injured child.

LEVEL OF EVIDENCE: IV - Study type: Prognostic and Epidemiological.