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May 9, 1990

Pediatric Trauma: Getting Triage Right-Reply

Author Affiliations

Madigan Army Medical Center Tacoma, Wash

Madigan Army Medical Center Tacoma, Wash

JAMA. 1990;263(18):2447. doi:10.1001/jama.1990.03440180045018

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In Reply.—  Dr Di Scala points out a valid concern. While overtriage is a resource utilization problem, undertriage resulting in inadequate medical care is important to the individual patient. This study used an Injury Severity Score of 15 as the indicator for appropriate triage in evaluating the Revised Trauma Score and the Pediatric Trauma Score as triage tools. Although an Injury Severity Score greater than 15 is often used as a proxy for severe injury and has been useful in evaluating populations of patients, this value is arbitrary and for an individual patient may either overestimate or underestimate the actual need for trauma center care. Other criteria of appropriate triage need to be developed.Examination of individual patients receiving undertriage by the Revised Trauma Score but not by the Pediatric Trauma Score may demonstrate that some of these patients did not actually need trauma center care as evaluated by other