Secondary overtriage in pediatric trauma: Can unnecessary patient transfers be avoided?

Seth D. Goldstein*, Kyle Van Arendonk, Jonathan K. Aboagye, Jose H. Salazar, Maria Michailidou, Susan Ziegfeld, Jeffrey Lukish, F. Dylan Stewart, Elliott R. Haut, Fizan Abdullah

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

34 Scopus citations


Background In an era of wide regionalization of pediatric trauma systems, interhospital patient transfer is common. Decisions regarding the location of definitive trauma care depend on prehospital destination criteria (primary triage) and interfacility transfers (secondary triage). Secondary overtriage can occur in any resource-limited setting but is not well characterized in pediatric trauma. Methods The National Trauma Data Bank from 2008 to 2011 was queried to identify patients 15 years or younger who were transferred to pediatric trauma centers. Secondary overtriage was defined as meeting all 4 of the following criteria: injury severity score (ISS) less than 9, no need for surgical procedure, no critical care admission, and length of stay of less than 24 hours. All other transfers were deemed appropriate triage. Results Our definition of secondary overtriage was met in 32,318 patients out of 144,420 transfers (22.4%). Within this group, 37.5% were discharged directly from the emergency department of the receiving hospital without hospital admission. Appropriately triaged patients required a therapeutic procedure in 43.5% of cases. Differences in age, sex, mechanism of injury, and payer status were modest. Conclusions Secondary overtriage is prevalent in pediatric trauma systems nationwide and is not associated with any particular patient characteristics. Because clinical outcomes and healthcare spending are increasingly scrutinized, secondary overtriage may reflect unnecessary patient transfer and a source of potential cost savings. Development of better guidelines for secondary triage of pediatric trauma patients may enable timely assessment and treatment of children who require a higher level of care while also preventing inefficient use of available resources.

Original languageEnglish (US)
Pages (from-to)1028-1031
Number of pages4
JournalJournal of pediatric surgery
Issue number6
StatePublished - Jun 1 2015


  • patient transfer
  • pediatric trauma
  • secondary overtriage
  • trauma triage

ASJC Scopus subject areas

  • Surgery
  • Pediatrics, Perinatology, and Child Health


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