Consequences of pediatric undertriage and overtriage in a statewide trauma system

被引:25
作者
Hewes, Hilary A. [1 ]
Christensen, Mathew [2 ]
Taillac, Peter P. [3 ]
Mann, N. Clay [4 ]
Jacobsen, Kammy K. [1 ]
Fenton, Stephen J. [5 ]
机构
[1] Univ Utah, Sch Med, Div Pediat Emergency Med, Salt Lake City, UT USA
[2] Utah Dept Hlth, Bur Emergency Med Serv & Preparedness, Salt Lake City, UT 84116 USA
[3] Univ Utah, Sch Med, Div Emergency Med, Salt Lake City, UT USA
[4] Univ Utah, Sch Med, Dept Pediat, Salt Lake City, UT USA
[5] Univ Utah, Sch Med, Div Pediat Surg, Salt Lake City, UT USA
关键词
Pediatric trauma; overtriage; undertriage; statewide trauma system; INJURED PATIENTS; INTERFACILITY TRANSFERS; EMERGENCY-DEPARTMENTS; LEVEL; OUTCOMES; CHILDREN; CENTERS; BENEFIT; TRIAGE; CARE;
D O I
10.1097/TA.0000000000001560
中图分类号
R4 [临床医学];
学科分类号
1002 ; 100602 ;
摘要
BACKGROUND: With increasing attention to the quality of health care delivery, evaluating trauma triage decisions in a large system of emergency care can help decision makers reduce mortality, morbidity, unnecessary transfers, and health care costs. OBJECTIVES: To quantify the magnitude of pediatric traumatic injury undertriage (hospital mortality risk) and overtriage (early trauma center discharge after transfer) in a statewide trauma system. METHODS: A statewide population-based evaluation of pediatric trauma outcomes and secondary triage (interfacility transfers) patterns from 2001 to 2013 among 45 hospitals in Utah's statewide trauma system. RESULTS: The odds of pediatric transfer were 13 times lower (odds ratio, 13.15; p < 0.0001; 95% confidence interval, 11.0-15.7) in acute care hospitals meeting undertriage criteria than hospitals meeting overtriage criteria. Hospital triage practice was a stronger predictor of pediatric transfer than injury severity, injury diagnoses, age, and geographic distance. The likelihood of pediatric trauma mortality was more than twice higher in undertriage hospitals than overtriage hospitals (OR, 2.44; p < 0.0001; 95% confidence interval, 1.5-3.8). Among pediatric patients that survived the injury to transfer, 61% were discharged from the pediatric center in < 24 hours. CONCLUSION: Substantial opportunity exists in the state trauma system to improve pediatric trauma patient transfer practices to reduce pediatric trauma mortality, morbidity, and health care costs associated with unnecessary transfers. Copyright (C) 2017 Wolters Kluwer Health, Inc. All rights reserved.
引用
收藏
页码:662 / 667
页数:6
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