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Prehospital triage in the injured pediatric patient
S A Engum1, M K Mitchell, L R Scherer
1James Whitcomb Riley Hospital for Children, Indiana University Regional Trauma Center, Indiana University School of Medicine, Indianapolis 46202, USA.
Insights
Prehospital trauma triage in children is crucial for effective resource allocation. A simplified 12-criterion system showed high sensitivity in identifying major pediatric trauma, though overtriage remains a concern.
Area of Science:
- Emergency Medicine
- Pediatric Trauma Care
- Prehospital Triage Systems
Background:
- Accurate identification of major trauma patients in the prehospital setting is vital for appropriate management and resource allocation.
- Existing trauma triage methods lack universal acceptance, necessitating evaluation of alternative systems.
- This study focuses on pediatric trauma patients, a population with unique physiological responses to injury.
Purpose of the Study:
- To prospectively evaluate the efficacy of a simplified 12-criterion field triage system for pediatric trauma patients.
- To compare the accuracy of this triage system in children versus adults.
- To identify the most accurate triage criteria for pediatric major trauma.
Main Methods:
- A prospective study involving 1,285 pediatric trauma patients and 1,326 adult trauma patients.
- Major trauma was defined by mortality, need for major surgery, or intensive care unit admission.
- Triage accuracy was determined by correlating 12 prehospital criteria with patient outcomes.
Main Results:
- Systolic blood pressure < or = 90 mmHg was the most accurate criterion (86%) for identifying major pediatric trauma.
- Glasgow Coma Scale score < or = 12 (78%) and burn > 15% total body surface area (79%) were also highly accurate.
- The simplified system achieved 100% sensitivity in detecting major pediatric trauma but had a 71% overtriage rate.
Conclusions:
- Physiological variables, anatomic site, and mechanism of injury form a sensitive and safe pediatric trauma triage system.
- Further education and refinement of current triage tools are needed to reduce overtriage in pediatric populations.
- The study highlights the need for specialized approaches to pediatric trauma triage to optimize care and resource utilization.
Background/Purpose:
Identifying major trauma patients in the prehospital setting is essential in determining management, destination, and best utilization of emergency department resources. Few methods of trauma triage have been accepted unanimously. This study prospectively evaluates the efficacy of comprehensive field triage using 12 criteria (simplified version of the American College of Surgeon's guidelines) in 1,285 pediatric trauma patients.
Methods:
Major trauma was defined as occurring in those who died in the emergency room, had major surgery (penetrating injury involving surgery of the head, neck, chest, abdomen, or groin), or were admitted directly to the intensive care unit. The correlation between trauma triage criteria, hospital disposition, and triage accuracy were determined prospectively and compared in the pediatric patients (36 months) with an adult cohort of patients (12 months).
Results:
A total of 1,285 pediatric trauma patients were evaluated and compared with 1,326 adult trauma patients. The most accurate trauma triage criterion for major injury was a blood pressure < or = 90 mmHg (systolic) with an accuracy of 86%. This was followed by burn greater than 15% total body surface area (79%), Glasgow Coma Scale score < or = 12 (78%), respiratory rate less than 10/min or greater than 29/min (73%), and paralysis (50%). Less accurate criteria included a fall from greater than 20 feet (33%); penetrating injury to head, neck, chest, abdomen, or groin (29%); ejection from vehicle (24%); pedestrian struck at greater than 20 mph (16%); paramedic judgement (12%); rollover (3%); and extrication (0%). The Glasgow Coma Scale score was a more accurate indicator of major injury in children than adults, and paramedic judgement was less accurate in children when compared with adults. Of the 379 major pediatric trauma victims, the Revised Trauma Score and Pediatric Trauma Score missed 36% and 45% of these major trauma victims, respectively. The overtriage rate for children was 71% with a sensitivity of 100% (no missed major trauma patients).
Conclusions:
Physiological variables, anatomic site, and mechanism of injury provide a sensitive and safe system of triage. Continued education of prehospital personnel regarding pediatric trauma and stratification of the current triage tools are necessary to minimize overtriage in an era of shrinking resources.
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