title: Secondary overtriage in pediatric trauma: can unnecessary patient transfers be avoided?
abstract: BACKGROUND
  In an era of wide regionalization of pediatric trauma systems, interhospital patient transfer is common. Decisions regarding the location of definitive trauma care depend on prehospital destination criteria (primary triage) and interfacility transfers (secondary triage). Secondary overtriage can occur in any resource-limited setting but is not well characterized in pediatric trauma.
  
  
  METHODS
  The National Trauma Data Bank from 2008 to 2011 was queried to identify patients 15 years or younger who were transferred to pediatric trauma centers. Secondary overtriage was defined as meeting all 4 of the following criteria: injury severity score (ISS) less than 9, no need for surgical procedure, no critical care admission, and length of stay of less than 24 hours. All other transfers were deemed appropriate triage.
  
  
  RESULTS
  Our definition of secondary overtriage was met in 32,318 patients out of 144,420 transfers (22.4%). Within this group, 37.5% were discharged directly from the emergency department of the receiving hospital without hospital admission. Appropriately triaged patients required a therapeutic procedure in 43.5% of cases. Differences in age, sex, mechanism of injury, and payer status were modest.
  
  
  CONCLUSIONS
  Secondary overtriage is prevalent in pediatric trauma systems nationwide and is not associated with any particular patient characteristics. Because clinical outcomes and healthcare spending are increasingly scrutinized, secondary overtriage may reflect unnecessary patient transfer and a source of potential cost savings. Development of better guidelines for secondary triage of pediatric trauma patients may enable timely assessment and treatment of children who require a higher level of care while also preventing inefficient use of available resources.
authors: Division of Pediatric Surgery, Johns Hopkins Hospital, Baltimore, MD. Electronic address: sgoldstein@jhmi.edu.
authors: Seth D
authors: SD
authors: Goldstein
authors: Division of Pediatric Surgery, Johns Hopkins Hospital, Baltimore, MD.
authors: Kyle
authors: K
authors: Van Arendonk
authors: Division of Pediatric Surgery, Johns Hopkins Hospital, Baltimore, MD.
authors: Jonathan K
authors: JK
authors: Aboagye
authors: Division of Pediatric Surgery, Johns Hopkins Hospital, Baltimore, MD.
authors: Jose H
authors: JH
authors: Salazar
authors: Division of Pediatric Surgery, Johns Hopkins Hospital, Baltimore, MD.
authors: Maria
authors: M
authors: Michailidou
authors: Division of Pediatric Surgery, Johns Hopkins Hospital, Baltimore, MD.
authors: Susan
authors: S
authors: Ziegfeld
authors: Division of Pediatric Surgery, Johns Hopkins Hospital, Baltimore, MD.
authors: Jeffrey
authors: J
authors: Lukish
authors: Division of Pediatric Surgery, Johns Hopkins Hospital, Baltimore, MD.
authors: F Dylan
authors: FD
authors: Stewart
authors: Division of Pediatric Surgery, Johns Hopkins Hospital, Baltimore, MD.
authors: Elliott R
authors: ER
authors: Haut
authors: Division of Pediatric Surgery, Johns Hopkins Hospital, Baltimore, MD.
authors: Fizan
authors: F
authors: Abdullah
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D016208:Databases, Factual; D005260:Female; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D015601:Injury Severity Score; D008297:Male; D000069342:Medical Overuse / Q000517:prevention & control / Q000706:statistics & numerical data*; D010360:Patient Transfer / Q000706:statistics & numerical data*; D014193:Trauma Centers / Q000706:statistics & numerical data*; D014218:Triage / Q000379:methods* / Q000706:statistics & numerical data; D014481:United States; D014947:Wounds and Injuries / Q000628:therapy*
keywords: patient transfer; pediatric trauma; secondary overtriage; trauma triage