Effectiveness of a pediatric trauma team protocol.
OBJECTIVE
To determine the effectiveness of a pediatric trauma triage system and resource allocation for emergency medicine and trauma services. TRAUMA SYSTEM: Two-tier trauma team activation system that triages patients into Level 1 and Level 2 trauma alert categories based on information provided by pre-hospital providers to pediatric emergency physicians at an American College of Surgeons' Level 1 pediatric trauma center in Columbus, Ohio.


METHODS
Using the hospital trauma registry database and patient medical records, a retrospective chart review was conducted on all (n = 542) admitted pediatric trauma patients from January 1995 through December 1996.


RESULTS
Level 1 patients had a higher median injury severity score and shorter emergency department (ED) length of stay time than Level 2 patients. Level 1 patients were more likely to be admitted to the pediatric intensive care unit and remain for more than 24 hours when compared to Level 2 patients. In addition, Level 1 patients were more likely to have procedures performed (eg, intubation, tube thoracostomy, thoracotomy, diagnostic peritoneal lavage) than Level 2 patients. The mortality rate was significantly higher for Level 1 patients and all ED deaths had been triaged to the Level 1 category.


CONCLUSIONS
This pediatric trauma triage system effectively predicts which patients will be more likely to have serious injury. By using a two-tier system, select patients may be managed by a smaller trauma team, thus improving staff utilization and possibly reducing costs while ensuring favorable outcomes.
Nuss
K E
KE
The Ohio State University College of Medicine and Public Health, Department of Pediatrics, Children's Hospital, Columbus 43205, USA. nussk@pediatrics.ohio-state.edu
Dietrich
A M
AM
Smith
G A
GA
D002648:Child; D002985:Clinical Protocols / Q000592:standards*; D003422:Critical Care / Q000592:standards; D004635:Emergency Medicine / Q000458:organization & administration / Q000592:standards*; D005260:Female; D006776:Hospitals, Pediatric; D006801:Humans; D008297:Male; D009820:Ohio; D010348:Patient Care Team / Q000458:organization & administration* / Q000592:standards; D010372:Pediatrics / Q000458:organization & administration / Q000592:standards*; D012189:Retrospective Studies; D014193:Trauma Centers / Q000592:standards*; D015599:Trauma Severity Indices; D014218:Triage / Q000458:organization & administration / Q000592:standards*; D014947:Wounds and Injuries / Q000145:classification* / Q000401:mortality / Q000628:therapy*