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Observational Study
. 2021 Jan 7;16(1):1.
doi: 10.1186/s13017-020-00345-w.

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

François-Xavier Ageron  1 , Jordan Porteaud  2 , Jean-Noël Evain  2 , Anne Millet  3 , Jules Greze  2 , Cécile Vallot  1 , Albrice Levrat  4 , Guillaume Mortamet  3   5 , Pierre Bouzat  6   7   8 ; TRENAU Group
Affiliations
Observational Study

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

François-Xavier Ageron et al. World J Emerg Surg. .

Abstract

Background: 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.

Methods: This 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.

Results: A 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]).

Conclusions: In a regional inclusive trauma system, under triage increased the risk of early death after pediatric major trauma.

Keywords: Major pediatric trauma; Mortality; Propensity score; Trauma system; Under triage.

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Conflict of interest statement

The authors declare that they have no competing interests.

Figures

Fig. 1
Fig. 1
Crude, inverse probability treatment weighting (IPTW) method, and propensity score (Ps) matching analyses to assess the risk of early death in under triaged children according to the need of specialized trauma care
Fig. 2
Fig. 2
Repartition of under triage rates across the TRENAU administrative sub-territories
See this image and copyright information in PMC

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