Memorial Regional Hospital, Hollywood, FL, USA.
Florida Atlantic University Charles E. Schmidt College of Medicine, Boca Raton, FL, USA.
Am Surg. 2024 Jul;90(7):1892-1895. doi: 10.1177/00031348241241693. Epub 2024 Mar 26.
Triage accuracy is essential for delivering effective trauma care, especially in the pediatric population where unique challenges exist. The purpose of this study was to investigate risk factors contributing to under-triage and over-triage in an urban pediatric trauma center.
This retrospective cohort study included all trauma activations at an urban level 1 trauma center between January 1, 2021, and July 31, 2023 (patients <18 years old.) Patients who were under- or over-triaged were identified based on the level of trauma activation and injury severity score.
There were 1094 trauma activations included in this study. The rate of under-triage was 3.8% (n = 42) and over-triage was 13.6% (n = 149). Infants aged 0-1 years had the highest rate of under-triage (10.9%, n = 19, < .001), while those aged 11-17 had the highest rate of over-triage (17.0%, n = 82, = .003). Non-accidental trauma was the strongest risk factor for under-triage (OR 30.2 [6.4-142.8] < .001). Penetrating mechanism was the strongest risk factor for over-triage (OR 12.2 [5.6-26.2] < .001).
This study reveals the complexity of trauma triage in the pediatric population. We identified key predictive factors, such as age, comorbidities, and mechanism of injury, that can be used to refine triage practices and improve the care of pediatric trauma patients.
分诊准确率对于提供有效的创伤护理至关重要，尤其是在儿科人群中，因为他们存在独特的挑战。本研究的目的是调查导致城市儿科创伤中心分诊不足和过度分诊的风险因素。
这是一项回顾性队列研究，纳入了 2021 年 1 月 1 日至 2023 年 7 月 31 日期间城市一级创伤中心所有创伤激活患者（年龄<18 岁）。根据创伤激活水平和损伤严重程度评分，确定分诊不足和过度分诊的患者。
本研究共纳入 1094 例创伤激活患者。分诊不足的发生率为 3.8%（n=42），过度分诊的发生率为 13.6%（n=149）。0-1 岁婴儿的分诊不足发生率最高（10.9%，n=19，<.001），而 11-17 岁的患者过度分诊发生率最高（17.0%，n=82，<.001）。非故意伤害是分诊不足的最强风险因素（OR 30.2[6.4-142.8]，<.001）。穿透性机制是过度分诊的最强风险因素（OR 12.2[5.6-26.2]，<.001）。
本研究揭示了儿科人群中创伤分诊的复杂性。我们确定了一些关键的预测因素，如年龄、合并症和损伤机制，这些因素可用于改进分诊实践，改善儿科创伤患者的护理。
