Risk of under Triage and Underestimation of Danger in the Pediatric Population with Major Trauma: Real-Life of a Level 2 Trauma Center

Background: The early failure to recognize major trauma and undertriages cause an increase in mortality and residual comorbidities.

Objective: Tescribe the risk of under triage and underestimation of the danger in the pediatric population that comes to the er for major trauma in a trauma center 2° level.

Methods: We enrolled patients aged ≤ 14 years who were consecutively referred to our ER from 1 January 2014 to 31 December 2018 for major trauma. We then analyzed the methods of arrival, hospital stay, the emergency codes at the medical examination, the severity code at the exit, the causes of the accident, the outcomes.

Results: We enrolled 99 patients. The average age was 7 years (59% M). 62% for major trauma, 35% for severe head injury, 3% for burns. 45% contracted the trauma on the road, 10% on the motocross track, 31% at home and 5% at school. Only 8% arrived self-presented, the remainder accompanied by the territorial emergency services (118 in Italy, equivalent to American 911). Of these, 1% came with helicopter rescue. 88% accessed the medical examination with a high priority code and required medium high intensity of care, however, 12% were not recognized in triage because they were clinically stable and with no major trauma dynamics. 98% had stable vital parameters (blood pressure, heart rate and saturimetry) at the entrance. The findings, however, did classify the patients as major trauma. Only 5% were discharged. 95% were hospitalized either because they needed an observation period (29% in pediatrics), or because they needed deferred surgery or high monitoring (12% in orthopedics, 26% in pediatric surgery). 15% needed hospitalization in intensive care.

Conclusion: The pediatric population is at high risk of undertriage. This may possibly be due to the child`s clinic, which only belatedly manifests signs of shock