• Richard A Falcone, Lynn Haas, Eileen King, Suzanne Moody, John Crow, Ann Moss, Barbara Gaines, Christine McKenna, David M Gourlay, Cinda Werner, David P Meagher, Lisa Schwing, Nilda Garcia, Deb Brown, Jonathan I Groner, Kathy Haley, Anthony Deross, Laura Cizmar, and Rochelle Armola.
• Division of Pediatric Surgery, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio 45229-3039, USA. richard.falcone@cchmc.org
• J Trauma Acute Care Surg. 2012 Aug 1;73(2):377-84; discussion 384.

BackgroundThe 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.MethodsData 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.ResultsDuring 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%.ConclusionThe 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.

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