Undertriage of Pediatric Major Trauma Patients in the United States

Although trauma undertriage has been widely discussed in the literature, undertriage in the pediatric trauma population remains understudied. Using the 2009-2013 Nationwide Emergency Department Sample, we assessed the national undertriage rate in pediatric major trauma patients (age 16 years and injury severity score [ISS] >15), and identified factors associated with pediatric trauma undertriage. Nationally, 21.7% of pediatric major trauma patients were undertriaged. Children living in rural areas were more likely to be undertriaged (P = .02), as were those without insurance (P = .00). Children with life-threatening injuries were less likely to be undertriaged (P < .0001), as were those with chronic conditions (P < .0001). Improving access to specialized pediatric trauma care through innovative service delivery models may reduce undertriage and improve outcomes for pediatric major trauma patients.