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External validation and modification of a pediatric trauma triage tool
Ahmed Nasr1, Angelo Mikrogianakis, Dorothy McDowall
1Department of General Surgery, The Hospital for Sick Children, University of Toronto, Canada.
The Journal of Trauma
|April 7, 2007
Summary
The modified pediatric trauma score (mPTS) improved sensitivity for identifying serious pediatric trauma, reducing unnecessary trauma team activations by 20%. This enhanced tool aids emergency room triage for pediatric trauma patients.
Area of Science:
- Pediatric Trauma Care
- Emergency Medicine
- Clinical Triage Tools
Background:
- The modified pediatric triage score (mPTS) was developed to identify pediatric trauma patients with a low likelihood of serious injury.
- This allows for emergency room treatment without full trauma team activation, optimizing resource allocation.
Purpose of the Study:
- To evaluate the effectiveness of the mPTS in a Level I pediatric trauma center population.
- To assess the sensitivity and predictive value of the original and a modified mPTS.
Main Methods:
- A retrospective cohort study of 628 pediatric trauma patients (1999-2002) was conducted, excluding penetrating trauma and burns.
- Patients were stratified by Injury Severity Score (ISS). The mPTS was applied, and a modified version including contusions and loss of consciousness was developed.
Main Results:
- The original mPTS showed 92% sensitivity and 47% positive predictive value (PPV), missing 21 significant injuries.
- The modified mPTS achieved 99% sensitivity and 46% PPV, with a 20% reduction in unnecessary trauma team activations.
Conclusions:
- The original mPTS lacked sufficient sensitivity for this pediatric trauma population.
- The modified Sick Kids mPTS demonstrated high sensitivity (99%) and a safe level of overtriage (46% PPV), effectively reducing trauma team activations by 20%.