Trauma remains a leading cause of death in children worldwide. Management in dedicated paediatric trauma centres is beneficial, making accurate prehospital triage crucial. We assessed undertriage in a regional trauma system after implementing a revised paediatric triage rule.

This retrospective, multicentre registry study included all injured children <15 years admitted to hospitals in the Northern French Alps with suspected major trauma and/or an Abbreviated Injury Scale ≥3. Triage performance was assessed before and after implementation of a revised paediatric triage rule. Multivariate logistic regression identified predictors of undertriage defined as a child with major trauma (need for trauma intervention) not directly transported to the paediatric trauma centre.

All 1524 injured children from January 2009 to December 2020 were included. Of these, 725/1524 (47.6%) presented with major trauma; 593/1524 (38.9%) were referred to a non-paediatric trauma centre, and 220/1524 (15%) were considered undertriaged. Over the years, undertriage decreased from 15% to 9%, after the implementation of a revised triage rule. After adjustment, revised paediatric triage rules decreased undertriage, OR = 0.5; 95% CI: 0.3–0.9; P < 0.02. The multivariate regression model identified the following risk factors of undertriage: children >10 years, two-wheel vehicle road traffic accident, girls after a fall, for boys after a winter ski accident, and infants with severe limb and pelvic injuries.

The implementation of regional revised triage rule contributed to a reduction in the paediatric undertriage rate to 9%; several clinical factors were associated with undertriage.