title: Physiologically focused triage criteria improve utilization of pediatric surgeon-directed trauma teams and reduce costs.
abstract: BACKGROUND
  Pediatric surgeon-directed trauma teams (STTs) provide lifesaving treatment but at a high cost. We used physiologically based criteria to improve STT utilization.
  
  
  METHODS
  We reviewed 152 consecutive STT activations at one center, comparing standard and physiologically focused criteria and 24-hour hospital costs/charges for overtriaged patients vs level 2 (emergency department managed) blunt trauma patients matched for age, Injury Severity Score (ISS), and necessity for operation.
  
  
  RESULTS
  Our cohort (73.0% male; 86.8% blunt; median age, 8.0 [interquartile range, 4.0-14.0] years) had 10 deaths (6.6%) and 18 (11.8%) emergent operations. Twenty-nine patients met neither standard nor physiologic criteria (group 1), 25 met standard but not physiologic criteria (overtriaged, group 2), and 98 met physiologic criteria (group 3). Group 3 had higher median ISS (19.0 [10.0-33.0] vs 10.0 [4.0-17.0] and 5.5 [5.0-16.75] for groups 1 and 2, P = .001), more intensive care unit admissions (67.2% vs 31.0% and 52.0%, P = .001), longer hospitalization (5.0 [3.0-9.25] days vs 3.0 [1.0-5.0] and 4.0 [2.0-5.0] days, P = .002), and all patients who died or required emergent operation (P < .001). Physiologic criteria maintained 100% sensitivity but improved specificity (49.2% vs 23.0%). Overtriaged patients (n = 18) had 78.2% higher charges ($4700; 95% confidence interval, 13.3%-180.1%; P = .013) and 53.4% higher costs ($800; 95% confidence interval, 1.8%-131.2%; P = .041) than level 2 patients (n = 259) after adjusting for age, ISS, and need for operation, largely because of computed tomography and emergency department charges (66% of overtriaged charges).
  
  
  CONCLUSIONS
  Physiologic STT activation criteria would have saved 25 activations, $20,000 in costs, and $120,000 in charges annually without compromising patient safety.
authors.affiliation: Section of Surgical Sciences, Vanderbilt University Medical Center, Nashville, TN, USA.
authors.forename: Kaushik
authors.initials: K
authors.lastname: Mukherjee
authors.forename: Mariann
authors.initials: M
authors.lastname: Rimer
authors.forename: Michael D
authors.initials: MD
authors.lastname: McConnell
authors.forename: Richard S
authors.initials: RS
authors.lastname: Miller
authors.forename: Stephen E
authors.initials: SE
authors.lastname: Morrow
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D005260:Female; D005500:Follow-Up Studies; D013502:General Surgery / Q000191:economics; D017048:Health Care Costs / Q000639:trends*; D006439:Hemodynamics / Q000502:physiology*; D006801:Humans; D008297:Male; D010348:Patient Care Team / Q000191:economics / Q000706:statistics & numerical data*; D014193:Trauma Centers; D015599:Trauma Severity Indices; D014218:Triage / Q000458:organization & administration*; D014481:United States; D000078329:Workforce; D014949:Wounds, Nonpenetrating / Q000145:classification* / Q000503:physiopathology / Q000601:surgery