Trauma systems have prioritized developing accurate triage methods to identify severely injured patients in order to get them expeditiously to the center with appropriate resources. Trauma activation levels determine which personnel and resources are present during the resuscitation of a patient. Under-triage of patients can be catastrophic if, the patient is transported to a center without appropriate capability or capacity or the necessary medical personnel are not available in the center to treat a patient urgently. Over-triage leads to alarm fatigue and unnecessary costs to the system. Unfortunately, there continues to be a lack of data focused on pediatric trauma triage criteria.

The Pediatric Trauma Society Research Committee conducted a systematic review and meta-analysis of the literature to evaluate if current triage criteria in the pre-hospital setting and in emergency departments are accurate in predicting severely injured children who require high-level resources.1 The authors identified only 38 publications that were included in the review, substantiating the fact that there remains a paucity of evidence on the topic of pediatric trauma triage. The study found that triage criteria based on physiologic indices were more predictive of outcome than mechanism of injury.

As we continue to focus on improving the trauma care delivered to pediatric patients, attention needs to be given on how to accurately triage patients in the field and upon arrival to the emergency departments. Several triage scoring tools that rely on physiologic parameters rather than mechanism of injury have been shown to be more precise in predicting severity of injury and need for trauma resources.2,3 Attention has also shifted towards intervention-based systems such as Need for Surgeon Presence (NSP) and Need For Trauma (team) Intervention (NFTI) to more accurately reflect the needs of the patient in real-time. 4,5 Additionally, overutilization of helicopter transport has incurred significant costs to the system, so identifying which patients actually benefit from this expensive resource should be prioritized.6,7 This article will explore the evidence that exists in the literature that addresses these important pediatric trauma triage issues.