Medical College of Wisconsin
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A multicenter prospective analysis of pediatric trauma activation criteria routinely used in addition to the six criteria of the American College of Surgeons. J Trauma Acute Care Surg 2012 Aug;73(2):377-84; discussion 384



Pubmed ID




Scopus ID

2-s2.0-84864592576   31 Citations


BACKGROUND: The 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.

METHODS: Data 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.

RESULTS: During 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%.

CONCLUSION: The 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.

Author List

Falcone RA Jr, Haas L, King E, Moody S, Crow J, Moss A, Gaines B, McKenna C, Gourlay DM, Werner C, Meagher DP Jr, Schwing L, Garcia N, Brown D, Groner JI, Haley K, Deross A, Cizmar L, Armola R


David M. Gourlay MD Chief, Professor in the Surgery department at Medical College of Wisconsin

MESH terms used to index this publication - Major topics in bold

Child, Preschool
Cohort Studies
Diagnostic Tests, Routine
Evidence-Based Medicine
Hospital Mortality
Injury Severity Score
Patient Care Team
Prospective Studies
Qualitative Research
Risk Assessment
Sensitivity and Specificity
Societies, Medical
Survival Analysis
Trauma Centers
Wounds and Injuries