title: Pediatric trauma transport performance measures in a mountain state: adherence and outcomes.
abstract: BACKGROUND
  Utah state trauma audit filters assess expeditious care at referring emergency departments for severely injured patients to avoid delays in transfer. We evaluated two state performance measures related to pediatric trauma care before arrival at the Level I trauma center.
  
  
  METHODS
  Analysis of the Primary Children's Medical Center (PCMC) trauma database for children with Injury Severity Scores (ISS)>15 from 2006 to 2009 was performed. Patient care was evaluated for referring hospital emergency department triage time of <2 hours and total transfer time of ≤6 hours for rural and ≤4 hours for urban place of injury.
  
  
  RESULTS
  Four hundred twelve patients with ISS>15 were admitted via interhospital transfer from within Utah. Approximately 50% of patients were triaged<2 hours, which increased to almost two thirds when restricted to those initially evaluated within 100 miles (helicopter range) of PCMC. Factors associated with delayed triaged included lower ISS, less severe head injury, greater distance from the trauma center, and primary chest/abdominal injuries. Death and poor outcome did not differ significantly by triage in <2 hours or ≥2 hours. Adherence with the total transfer time goal was 94% for rural and 76% for urban place of injury.
  
  
  CONCLUSIONS
  There was substantial nonadherence with trauma performance measures for triage in <2 hours among pediatric trauma patients with ISS >15. Because of low rates of poor outcome, we are unable to determine whether adherence with state triage goals lessens morbidity or mortality.
authors.affiliation: Department of Pediatrics, University of Utah, Salt Lake City, Utah 84158-1289, USA. Stephen.Gleich@hsc.utah.edu
authors.forename: Stephen J
authors.initials: SJ
authors.lastname: Gleich
authors.forename: Tellen D
authors.initials: TD
authors.lastname: Bennett
authors.forename: Susan L
authors.initials: SL
authors.lastname: Bratton
authors.forename: Gitte Y
authors.initials: GY
authors.lastname: Larsen
mesh_terms: D016009:Chi-Square Distribution; D002648:Child; D002675:Child, Preschool; D004636:Emergency Service, Hospital / Q000592:standards / Q000706:statistics & numerical data; D005260:Female; D015600:Glasgow Coma Scale; D006040:Goals; D019983:Guideline Adherence / Q000592:standards / Q000706:statistics & numerical data; D006801:Humans; D007223:Infant; D015601:Injury Severity Score; D016015:Logistic Models; D008297:Male; D017063:Outcome Assessment, Health Care; D010360:Patient Transfer / Q000592:standards* / Q000706:statistics & numerical data; D019984:Quality Indicators, Health Care / Q000592:standards / Q000706:statistics & numerical data; D018709:Statistics, Nonparametric; D013997:Time Factors; D014193:Trauma Centers / Q000592:standards / Q000706:statistics & numerical data; D014218:Triage / Q000592:standards / Q000706:statistics & numerical data; D014589:Utah; D014947:Wounds and Injuries / Q000628:therapy*