Trauma team activation for pediatric patients in Denmark: a multicenter study of criteria, organization, and injury severity

BACKGROUND: 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. METHODS: We conducted a retrospective multicenter cohort study including all pediatric trauma patients (< 18 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 < 15. RESULTS: 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 ≥ 15, 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 ≥ 25), head and thoracic injuries predominated. CONCLUSION: 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.