title: A multicenter prospective analysis of pediatric trauma activation criteria routinely used in addition to the six criteria of the American College of Surgeons.
abstract: BACKGROUND
  The American College of Surgeons has defined six minimum activation criteria (ACS-6) for the highest level of trauma activations at trauma centers. The verification criteria also allow for the inclusion of additional criteria at the institution's discretion. The purpose of this prospective multicenter study was to evaluate the ACS-6 as well as commonly used activation criteria to evaluate overtriage and undertriage rates for pediatric trauma team activation.
  
  
  METHODS
  Data were prospectively collected at nine pediatric trauma centers to examine 29 commonly used activation criteria. Patients meeting any of these criteria were evaluated for the use of high-level trauma resuscitation resources according to an expert consensus list. Patients requiring a resource but not meeting any activation criteria were included to evaluate undertriage rates.
  
  
  RESULTS
  During the 1-year study, a total of 656 patients were enrolled with a mean age of 8 years, a median Injury Severity Score of 14, and mortality of 11%. Using all criteria, 55% of patients would have been overtriaged and 9% would have been undertriaged. If only the ACS-6 were used, 24% of patients would have been overtriaged and 16% would have been undertriaged. Among activation criteria with more than 10 patients, those most predictive of using a high-level resource were a gunshot wound to the abdomen (92%), blood given before arrival (83%), traumatic arrest (83%), tachycardia/poor perfusion (83%), and age-appropriate hypotension (77%). The addition of tachycardia/poor perfusion and pretrauma center resuscitation with greater than 40 mL/kg results in eight criteria with an overtriage of 39% and an undertriage of 10.5%.
  
  
  CONCLUSIONS
  The ACS-6 provides a reliable overtriage or undertriage rate for pediatric patients. The inclusion of two additional criteria can further improve these rates while maintianing a simplified triage list for children.
authors: Division of Pediatric Surgery, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio 45229-3039, USA. richard.falcone@cchmc.org
authors: Richard A
authors: RA
authors: Falcone
authors: Lynn
authors: L
authors: Haas
authors: Eileen
authors: E
authors: King
authors: Suzanne
authors: S
authors: Moody
authors: John
authors: J
authors: Crow
authors: Ann
authors: A
authors: Moss
authors: Barbara
authors: B
authors: Gaines
authors: Christine
authors: C
authors: McKenna
authors: David M
authors: DM
authors: Gourlay
authors: Cinda
authors: C
authors: Werner
authors: David P
authors: DP
authors: Meagher
authors: Lisa
authors: L
authors: Schwing
authors: Nilda
authors: N
authors: Garcia
authors: Deb
authors: D
authors: Brown
authors: Jonathan I
authors: JI
authors: Groner
authors: Kathy
authors: K
authors: Haley
authors: Anthony
authors: A
authors: Deross
authors: Laura
authors: L
authors: Cizmar
authors: Rochelle
authors: R
authors: Armola
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D003955:Diagnostic Tests, Routine / Q000379:methods*; D019317:Evidence-Based Medicine; D005260:Female; D017052:Hospital Mortality / Q000639:trends; D006801:Humans; D015601:Injury Severity Score; D008297:Male; D010348:Patient Care Team / Q000458:organization & administration; D011446:Prospective Studies; D036301:Qualitative Research; D018570:Risk Assessment; D012680:Sensitivity and Specificity; D012955:Societies, Medical; D016019:Survival Analysis; D014193:Trauma Centers / Q000458:organization & administration*; D014218:Triage / Q000379:methods / Q000592:standards*; D014947:Wounds and Injuries / Q000145:classification* / Q000175:diagnosis / Q000401:mortality