A multicenter prospective analysis of pediatric trauma activation criteria routinely used in addition to the six criteria of the American College of Surgeons.

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%. CONCLUSION: 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.

Development of a pediatric Level 1 trauma center at a freestanding children's hospital: staff attitudes and perceptions before and after trauma designation.

BACKGROUND: Despite research correlating survival or better outcomes with pediatric trauma care at pediatric hospitals, almost 90% of injured children are treated at predominantly adult facilities. Although the reasons are likely multifactorial, attitudes of pediatric hospital staff may play a role in the development of a pediatric trauma center. METHODS: A survey of hospital staff was conducted to measure the attitude of staff on the effects of becoming a pediatric trauma center. The instrument was administered before and 6 months after trauma center designation. Major topic areas were staffing, organizational impact, education, safety, and financial issues. Attitudes were measured by Likert scale and compared between phases. RESULTS: A total of 404 staff participated before and 447 staff participated 6 months after designation. Nonphysician respondents dominated the survey respondent pool. Areas of concern included staffing, education, patient volume and acuity, and order and flow. Positive attitudes were seen in areas including quality of care, skill development, and recruitment. Overall improvement in attitudes was observed in several areas. CONCLUSIONS: Hospital staff consistently agreed on the positive impact on quality of care and overall employee benefit. Concerns were mostly diminished at follow-up. A persistent concern of adequate staffing mismatched actual needs. The findings of this study indicate that the staff perceive many measurable benefits to pediatric trauma center development, which have never previously been described.