Some Kids' Injuries Get Too Much Care,
Study Finds

Laird Harrison

January 08, 2020

Paramedics often refer children injured by motor vehicle traffic and firearms for trauma care that is unnecessary, researchers say.

Other injury mechanisms are not associated with overtriage, according to Jessica Lynn Ryan, DrPH, of the University of West Florida in Pensacola, and colleagues.

Their findings were published online December 29 in Trauma Surgery & Acute Care Open.

When paramedics arrive at the point of injury, they may need to make quick decisions about whether or not a patient needs trauma care.

However, say the investigators, there is currently a lack of reliable triage guidelines for pediatric patients, and paramedics are sometimes forced to rely on potentially unreliable criteria such as mechanism of injury to determine if a trauma alert is appropriate.

Studies on the efficacy of triage decisions based on mechanism of injury have produced conflicting results: some researchers have concluded that mechanism of injury is a useful proxy for trauma and others have determined that trauma alerts based on mechanism of injury are often unnecessary, a phenomenon known as overtriage.

Overtriage may lead to excessive healthcare costs for patients and trauma care facilities, as well as the misallocation of scarce medical resources.

To learn more about factors associated with overtriaging, Ryan and colleagues studied medical billing data obtained on 609 pediatric patients in Florida.

The study consisted of pediatric patients aged 5 to 15 years who had been admitted to either trauma or emergency care, but who were deemed by researchers not to have needed trauma care.

To limit their sample to only those patients for whom trauma care would have been unnecessary, the researchers excluded patients who were transferred from another hospital, incurred operating room charges (indicating that the patient had needed surgery), had a length of stay greater than 24 hours, had not had routine discharge to home or self-care, or had an International Classification of Diseases-9th Revision-Clinical Modification Injury Severity Score of less than 0.90.

The study was further limited to those patients for whom a mechanism of injury could be determined. As the sample was limited only to those patients for whom trauma alerts were unnecessary, any patient in the sample who had received a trauma alert could be considered to have been overtriaged.

Analysis of the data using linear regression models determined that most mechanisms of injury are not associated with overtriaging, and the researchers conclude that, "While triage criteria include physiologic and anatomic indicators, we see value in using injury mechanism as well in triage of youth patients."

However, firearms, motor vehicle traffic, and burns were strongly associated with overtriaging. Nine out of 14 (64.3%) patients injured by firearms and 26 out of 91 (28.6%) injured in motor vehicle traffic were overtriaged.

The difference in the percentage overtriaged was statistically significant for both firearms (P = .03) and motor vehicle traffic (P < .0001) compared with those injured in falls.

Although overtriaging did not appear to be a significant systemic problem in Florida hospitals in general, it can still impose a heavy financial burden on the families of overtriaged patients.

"Most of the overtriaged demographic groups had costs nearly twice those who were not identified as trauma alerts," the researchers write. People injured by motor vehicle crashes had an average trauma alert charge of $2655. Firearms had the highest average trauma alert charge of $6705.

In light of the high costs associated with overtriage, the authors recommend that more research be conducted with the aim of mitigating the problem of overtriage of patients with motor vehicle traffic and firearm inuries.

Dashiell Harrison contributed to this article.

The authors have disclosed no relevant financial relationships.

Trauma Surg Acute Care Open. Published online December 29, 2019. Full text

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