{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,11]],"date-time":"2026-05-11T10:19:04Z","timestamp":1778494744969,"version":"3.51.4"},"reference-count":36,"publisher":"Springer Science and Business Media LLC","issue":"1","license":[{"start":{"date-parts":[[2026,5,11]],"date-time":"2026-05-11T00:00:00Z","timestamp":1778457600000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2026,5,11]],"date-time":"2026-05-11T00:00:00Z","timestamp":1778457600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"funder":[{"DOI":"10.13039\/100007605","name":"Aarhus Universitet","doi-asserted-by":"crossref","id":[{"id":"10.13039\/100007605","id-type":"DOI","asserted-by":"crossref"}]}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["Eur J Trauma Emerg Surg"],"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Pediatric trauma team activation (TTA) is intended to ensure timely management of severely injured children, yet both prehospital visitation practices and in-hospital TTA criteria vary across trauma systems. The aim of this study was to describe and compare pediatric TTA criteria, organizational models, and injury severity across all Danish level I trauma centers.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We conducted a retrospective multicenter cohort study including all pediatric trauma patients (&lt;\u200918 years) admitted via TTA at the four Danish level I trauma centers between 2014 and 2024. Center-specific prehospital and in-hospital TTA protocols were obtained through structured inquiries. Injury severity was assessed using Injury Severity Score (ISS) and Abbreviated Injury Scale (AIS). Overtriage was defined as TTA in patients with ISS\u2009&lt;\u200915.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>A total of 3,452 pediatric trauma patients were included. Two distinct TTA models (single-criterion and point-based) and four organizational structures were identified. Overall, 14% of patients had ISS\u2009\u2265\u200915, corresponding to high overtriage across all centers. Overtriage rates ranged from 81% to 95% and were highest at centers using point-based TTA models. Mortality was low and did not differ significantly between centers. Among the most severely injured patients (ISS\u2009\u2265\u200925), head and thoracic injuries predominated.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Pediatric trauma triage in Denmark shows substantial inter-center variation combined with consistently high overtriage. These findings suggest a misalignment between current TTA practices and pediatric injury severity profiles. Greater alignment of pediatric-specific triage criteria across prehospital and in-hospital settings may support more accurate TTA, promote consistent care, and improve resource utilization across trauma centers.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1007\/s00068-026-03208-2","type":"journal-article","created":{"date-parts":[[2026,5,11]],"date-time":"2026-05-11T09:57:52Z","timestamp":1778493472000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Trauma team activation for pediatric patients in Denmark: a multicenter study of criteria, organization, and injury severity"],"prefix":"10.1007","volume":"52","author":[{"ORCID":"https:\/\/orcid.org\/0009-0008-0742-1736","authenticated-orcid":false,"given":"Christina H\u00f8jfeldt","family":"Nordestgaard","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2888-1842","authenticated-orcid":false,"given":"Martin Faurholdt","family":"Gude","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0009-0009-8866-5421","authenticated-orcid":false,"given":"Sara Viskum","family":"Leth","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7392-5854","authenticated-orcid":false,"given":"Nikolaj","family":"Raaber","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"297","published-online":{"date-parts":[[2026,5,11]]},"reference":[{"key":"3208_CR1","doi-asserted-by":"crossref","unstructured":"Williams D, et al. Trauma activation: are we making the right call? A 3-year experience at a Level I pediatric trauma center. J Pediatr Surg. 2011(10):1985-91. https:\/\/doi.org\/10.1016\/j.jpedsurg.2011.06.001.","DOI":"10.1016\/j.jpedsurg.2011.06.001"},{"key":"3208_CR2","unstructured":"Manciaux M, Romer CJ. Accidents in children, adolescents and young adults: a major public health problem. World Health Stat Q. 1986(3):227\u2009\u2013\u200931."},{"key":"3208_CR3","doi-asserted-by":"crossref","unstructured":"MacKenzie EJ, et al. A national evaluation of the effect of trauma-center care on mortality. N Engl J Med. 2006(4): 366\u2009\u2013\u200978. https:\/\/doi.org\/10.1056\/NEJMsa052049.","DOI":"10.1056\/NEJMsa052049"},{"key":"3208_CR4","doi-asserted-by":"crossref","unstructured":"Newgard CD, et al. Association of emergency department pediatric readiness with mortality to 1 year among injured children treated at trauma centers. JAMA Surg. 2022(4): e217419. https:\/\/doi.org\/10.1001\/jamasurg.2021.7419.","DOI":"10.1001\/jamasurg.2021.7419"},{"key":"3208_CR5","doi-asserted-by":"crossref","unstructured":"Stafford PW, Blinman TA, Nance ML. Practical points in evaluation and resuscitation of the injured child. Surg Clin North Am. 2002(2): 273\u2013301. https:\/\/doi.org\/10.1016\/s0039-61090200006-3.","DOI":"10.1016\/S0039-6109(02)00006-3"},{"key":"3208_CR6","doi-asserted-by":"crossref","unstructured":"Osler TM, et al. Do pediatric trauma centers have better survival rates than adult trauma centers? an examination of the national Pediatric Trauma Registry. J Trauma. 2001(1): 96\u2013101. https:\/\/doi.org\/10.1097\/00005373-200101000-00017.","DOI":"10.1097\/00005373-200101000-00017"},{"key":"3208_CR7","doi-asserted-by":"crossref","unstructured":"Lupton JR, et al. Under-triage and over-triage using the field triage guidelines for injured patients: a systematic review. Prehosp Emerg Care. 2023(1): 38\u201345. https:\/\/doi.org\/10.1080\/10903127.2022.2043963","DOI":"10.1080\/10903127.2022.2043963"},{"key":"3208_CR8","doi-asserted-by":"crossref","unstructured":"Kassam-Adams N, et al. Trauma-informed and family-centered paediatric resuscitation: defining domains and practices. Resusc Plus. 2023: 100374. https:\/\/doi.org\/10.1016\/j.resplu.2023.100374","DOI":"10.1016\/j.resplu.2023.100374"},{"key":"3208_CR9","doi-asserted-by":"crossref","unstructured":"Drendel AL, Gray MP, Lerner EB. A systematic review of hospital trauma team activation criteria for children. Pediatr Emerg Care. 2019(1):8\u201315. https:\/\/doi.org\/10.1097\/pec.0000000000001256.","DOI":"10.1097\/PEC.0000000000001256"},{"key":"3208_CR10","doi-asserted-by":"crossref","unstructured":"Mora MC et al. Pediatric trauma triage: A pediatric trauma society research committee systematic review. J Trauma Acute Care Surg. 2020(4): 623\u2013630. https:\/\/doi.org\/10.1097\/ta.0000000000002713","DOI":"10.1097\/TA.0000000000002713"},{"key":"3208_CR11","doi-asserted-by":"crossref","unstructured":"Weile J, et al. Trauma facilities in Denmark - a nationwide cross-sectional benchmark study of facilities and trauma care organisation. Scand J Trauma Resusc Emerg Med. 2018(1): 22. https:\/\/doi.org\/10.1186\/s13049-018-0486-1.","DOI":"10.1186\/s13049-018-0486-1"},{"key":"3208_CR12","doi-asserted-by":"crossref","unstructured":"van der Sluijs R, et al. Accuracy of pediatric trauma field triage: a systematic review. JAMA Surg. 2018(7): 671\u2013676. https:\/\/doi.org\/10.1001\/jamasurg.2018.1050.","DOI":"10.1001\/jamasurg.2018.1050"},{"key":"3208_CR13","doi-asserted-by":"crossref","unstructured":"McCarthy A, Curtis K, Holland AJ. Paediatric trauma systems and their impact on the health outcomes of severely injured children: An integrative review. Injury, 2016(3): 574\u2009\u2013\u200985. https:\/\/doi.org\/10.1016\/j.injury.2015.12.028.","DOI":"10.1016\/j.injury.2015.12.028"},{"key":"3208_CR14","unstructured":"Faergemann C. Characteristics of severely injured children admitted to a Danish trauma centre. Dan Med J. 2021(10)."},{"key":"3208_CR15","doi-asserted-by":"crossref","unstructured":"Ekstr\u00f6m DS, et al. Children and adolescents admitted to a university-level trauma centre in Denmark 2002\u20132011. Dan Med J. 2017(4).","DOI":"10.1136\/injuryprev-2016-042156.947"},{"key":"3208_CR16","unstructured":"Hansen OM, et al. Characteristics and outcomes of paediatric patients admitted to a Danish level-1 trauma centre. Dan Med J. 2020(7)."},{"key":"3208_CR17","doi-asserted-by":"crossref","unstructured":"Cintean R, et al. Epidemiology, patterns, and mechanisms of pediatric trauma: a review of 12,508 patients. Eur J Trauma Emerg Surg. 2023(1): 451\u2013459. https:\/\/doi.org\/10.1007\/s00068-022-02088-6.","DOI":"10.1007\/s00068-022-02088-6"},{"key":"3208_CR18","doi-asserted-by":"crossref","unstructured":"Bradshaw CJ, et al. International study of the epidemiology of paediatric trauma: PAPSA research study. World J Surg. 2018(6): 1885\u20131894. https:\/\/doi.org\/10.1007\/s00268-017-4396-6.","DOI":"10.1007\/s00268-017-4396-6"},{"key":"3208_CR19","unstructured":"STROBE statement. 2025; Available from: https:\/\/www.strobe-statement.org."},{"key":"3208_CR20","unstructured":"Danmark Statistik. 2025; Available from: https:\/\/www.dst.dk\/da\/Statistik\/emner\/borgere\/befolkning\/befolkningstal."},{"key":"3208_CR21","unstructured":"Danish trauma registry - Annual Report. 2024. Danish trauma registry 2024;15 August 2024; Available from: https:\/\/www.sundk.dk\/media\/m5u5w4nh\/687cf63e724340c29e1fb326b487b89c.pdf."},{"key":"3208_CR22","doi-asserted-by":"crossref","unstructured":"Baker SP, O\u2019Neill B. The injury severity score: an update. J Trauma, 1976(11): 882-5. https:\/\/doi.org\/10.1097\/00005373-197611000-00006.","DOI":"10.1097\/00005373-197611000-00006"},{"key":"3208_CR23","doi-asserted-by":"crossref","unstructured":"Linder F et al. Better compliance with triage criteria in trauma would reduce costs with maintained patient safety. Eur J Emerg Med. 2019(4):283\u2013288. https:\/\/doi.org\/10.1097\/mej.0000000000000544.","DOI":"10.1097\/MEJ.0000000000000544"},{"key":"3208_CR24","unstructured":"Resources for optimal care of the injured patient. an update. Task force of the committee on trauma, American college of surgeons. Bull Am Coll Surg. 1990(9): 20\u2009\u2013\u20099."},{"key":"3208_CR25","doi-asserted-by":"crossref","unstructured":"Price MS et al. Pediatric trauma over a decade: demographics, mechanisms of injury, and mortality at a major Danish trauma center-a retrospective cohort study. Scand J Trauma Resusc Emerg Med. 2025(1):39. https:\/\/doi.org\/10.1186\/s13049-025-01348-9.","DOI":"10.1186\/s13049-025-01348-9"},{"key":"3208_CR26","doi-asserted-by":"crossref","unstructured":"Newgard CD, et al. Role of guideline adherence in improving field triage. Prehosp Emerg Care. 2017(5): 545\u2013555. https:\/\/doi.org\/10.1080\/10903127.2017.1308612.","DOI":"10.1080\/10903127.2017.1308612"},{"key":"3208_CR27","doi-asserted-by":"crossref","unstructured":"Ngo LC, et al. Optimizing triage practice in pediatric trauma: lessons from under-triage and over-triage rates and risk factors. Am Surg, 2024(7): 1892\u20131895. https:\/\/doi.org\/10.1177\/00031348241241693.","DOI":"10.1177\/00031348241241693"},{"key":"3208_CR28","doi-asserted-by":"crossref","unstructured":"Herren A, et al. Pediatric Trauma and trauma team activation in a swiss pediatric emergency department: an observational cohort study. Child (Basel). 2023;8. https:\/\/doi.org\/10.3390\/children10081377.","DOI":"10.3390\/children10081377"},{"key":"3208_CR29","doi-asserted-by":"crossref","unstructured":"Escobar MA Jr., Morris CJ. Using a multidisciplinary and evidence-based approach to decrease undertriage and overtriage of pediatric trauma patients. J Pediatr Surg, 2016(9):1518-25. https:\/\/doi.org\/10.1016\/j.jpedsurg.2016.04.010.","DOI":"10.1016\/j.jpedsurg.2016.04.010"},{"key":"3208_CR30","doi-asserted-by":"crossref","unstructured":"Brown JB et al. The value of the injury severity score in pediatric trauma: time for a new definition of severe injury? J Trauma Acute Care Surg. 2017(6): 995\u20131001. https:\/\/doi.org\/10.1097\/ta.0000000000001440","DOI":"10.1097\/TA.0000000000001440"},{"key":"3208_CR31","doi-asserted-by":"crossref","unstructured":"Buschmann C et al. Major trauma with multiple injuries in German children: a retrospective review. J Pediatr Orthop. 2008(1): 1\u20135. https:\/\/doi.org\/10.1097\/BPO.0b013e31815b4d90.","DOI":"10.1097\/BPO.0b013e31815b4d90"},{"key":"3208_CR32","doi-asserted-by":"crossref","unstructured":"Naqvi G et al. Mechanisms, patterns and outcomes of paediatric polytrauma in a UK major trauma centre. Ann R Coll Surg Engl. 2017(1): 39\u201345. https:\/\/doi.org\/10.1308\/rcsann.2016.0222.","DOI":"10.1308\/rcsann.2016.0222"},{"key":"3208_CR33","doi-asserted-by":"crossref","unstructured":"Mullen S et al. Comparison of injury patterns and interventions between adolescent, adult and paediatric trauma cases: a cross-sectional review of TARN data. BMJ Open. 2023(5): e064101. https:\/\/doi.org\/10.1136\/bmjopen-2022-064101.","DOI":"10.1136\/bmjopen-2022-064101"},{"key":"3208_CR34","doi-asserted-by":"crossref","unstructured":"Tracy ET, et al. Pediatric injury patterns by year of age. J Pediatr Surg. 2013(6): 1384-8. https:\/\/doi.org\/10.1016\/j.jpedsurg.2013.03.041","DOI":"10.1016\/j.jpedsurg.2013.03.041"},{"key":"3208_CR35","unstructured":"Traumeregister D, [cited. 2023; Available from: https:\/\/www.sundk.dk\/media\/liswbzc4\/abff805037664fbc992e47d10fbf780f.pdf"},{"key":"3208_CR36","doi-asserted-by":"crossref","unstructured":"Gorski JK, et al. Comparison of vital sign cutoffs to identify children with major trauma. JAMA Netw Open, 2024(2): e2356472. https:\/\/doi.org\/10.1001\/jamanetworkopen.2023.56472.","DOI":"10.1001\/jamanetworkopen.2023.56472"}],"container-title":["European Journal of Trauma and Emergency Surgery"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s00068-026-03208-2.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/article\/10.1007\/s00068-026-03208-2","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s00068-026-03208-2.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,5,11]],"date-time":"2026-05-11T09:58:21Z","timestamp":1778493501000},"score":1,"resource":{"primary":{"URL":"https:\/\/link.springer.com\/10.1007\/s00068-026-03208-2"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,5,11]]},"references-count":36,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2026,12]]}},"alternative-id":["3208"],"URL":"https:\/\/doi.org\/10.1007\/s00068-026-03208-2","relation":{},"ISSN":["1863-9941"],"issn-type":[{"value":"1863-9941","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,5,11]]},"assertion":[{"value":"30 January 2026","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"3 May 2026","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"11 May 2026","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"According to Danish legislation, ethical approval from a regional research ethics committee is not required for register-based studies that do not involve biological material or direct patient contact. Therefore, formal ethical approval was waived. Approval for the use of data was obtained from the Legal Department of the Central Denmark Region (journal no. 1-16-02-89-25), and the study was registered with and approved by the regional data protection authorities in accordance with the General Data Protection Regulation (GDPR).","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethics approval and consent to participate"}},{"value":"Not applicable.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Consent for publication"}},{"value":"The authors declare no competing interests.","order":4,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}}],"article-number":"163"}}