Improving paediatric undertriage in a regional trauma network - A registry cohort study

Abstract

Background: Trauma remains a leading cause of death in children worldwide. Management in dedicated paediatric trauma centres is beneficial, making accurate prehospital triage crucial. We assessed undertriage in a regional trauma system after implementing a revised paediatric triage rule.

Methods: This retrospective, multicentre registry study included all injured children <15 years admitted to hospitals in the Northern French Alps with suspected major trauma and/or an Abbreviated Injury Scale ≥3. Triage performance was assessed before and after implementation of a revised paediatric triage rule. Multivariate logistic regression identified predictors of undertriage defined as a child with major trauma (need for trauma intervention) not directly transported to the paediatric trauma centre.

Results: All 1524 injured children from January 2009 to December 2020 were included. Of these, 725/1524 (47.6%) presented with major trauma; 593/1524 (38.9%) were referred to a non-paediatric trauma centre, and 220/1524 (15%) were considered undertriaged. Over the years, undertriage decreased from 15% to 9%, after the implementation of a revised triage rule. After adjustment, revised paediatric triage rules decreased undertriage, OR = 0.5; 95% CI: 0.3-0.9; P < 0.02. The multivariate regression model identified the following risk factors of undertriage: children >10 years, two-wheel vehicle road traffic accident, girls after a fall, for boys after a winter ski accident, and infants with severe limb and pelvic injuries.

Conclusion: The implementation of regional revised triage rule contributed to a reduction in the paediatric undertriage rate to 9%; several clinical factors were associated with undertriage.

Keywords: Paediatric trauma; Trauma system; Triage; Undertriage.