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The predictive value and appropriate ranges of prehospital physiological parameters for high-risk injured children
Craig D Newgard1, Michael Cudnik, Craig R Warden
1Center for Policy and Research in Emergency Medicine, Oregon Health & Science University, Portland, OR 97239-3098, USA. newgardc@ohsu.edu
Insights
Prehospital Glasgow Coma Scale (GCS) and respiratory rate best identify high-risk injured children. Age-specific criteria for respiratory rate, heart rate, and blood pressure are recommended for pediatric trauma assessment.
Area of Science:
- Pediatric Emergency Medicine
- Trauma Care
- Prehospital Services
Background:
- Identifying high-risk injured children in prehospital settings is crucial for timely and appropriate care.
- Established physiological measures are used, but their relative importance and age-appropriateness in pediatric trauma are not fully understood.
- Understanding these factors can optimize triage and improve outcomes for critically injured children.
Purpose of the Study:
- To determine the relative importance of prehospital physiological measures in identifying high-risk injured children.
- To investigate whether age-based criteria are necessary for different prehospital physiological measures.
- To define outcome-based appropriate ranges for physiological measures in injured children across various age groups.
Main Methods:
- Retrospective cohort analysis of 3877 injured children (0-14 years) transported by emergency medical services.
- Analysis of prehospital physiological data: Glasgow Coma Scale (GCS), systolic blood pressure (SBP), respiratory rate (RR), heart rate, and shock index.
- High-risk definition included mortality, major surgery, ICU stay ≥ 2 days, or Injury Severity Score ≥ 16; age groups: 0-2, 3-5, 6-10, 11-14 years.
Main Results:
- Prehospital GCS was the most significant predictor of high-risk status, followed by airway intervention and RR.
- Age significantly modified the predictive value of RR, heart rate, and SBP (P < 0.05 for all).
- A consistent linear relationship between GCS and outcomes was observed across all pediatric age groups.
Conclusions:
- Prehospital GCS and indicators of respiratory compromise are paramount for identifying high-risk injured children.
- Age-specific criteria for assessing RR, heart rate, and SBP are recommended in pediatric trauma.
- These findings can refine prehospital triage protocols for injured children.
Objectives:
To assess: (1) the relative importance of prehospital physiological measures in identifying high-risk children; (2) whether different age-based criteria should be used for each prehospital physiological measure; and (3) outcome-based appropriate ranges of physiological measures in injured children.
Methods:
This was a retrospective cohort analysis of injured children 0 to 14 years transported by emergency medical services to 48 statewide hospitals from January 1, 1998, through December 31, 2003. We analyzed prehospital physiological measures, including Glasgow Coma Scale score (GCS), systolic blood pressure (SBP), respiratory rate (RR), heart rate, shock index (heart rate/SBP), and airway intervention. "High-risk" children were defined as those with in-hospital mortality, major nonorthopedic surgery, intensive care unit stay greater than or equal to 2 days, or Injury Severity Score greater than or equal to 16. Specific age groups included 0 to 2 years, 3 to 5 years, 6 to 10 years, and 11 to 14 years.
Results:
A total of 3877 injured children were included in the analysis, of which 1111 (29%) were high risk. Prehospital GCS was the variable of greatest importance in identifying high-risk children, followed by (in order) airway intervention, RR, heart rate, SBP, and shock index. Age modified the effect of prehospital RR (P = 0.0046), heart rate (P = 0.01), and SBP (P = 0.02). There was a linear relationship between GCS and outcome that was consistent across all ages. Specific age-based ranges of other physiological measures were identified for high-risk children.
Conclusions:
Prehospital GCS and respiratory compromise were the most important physiological measures in identifying high-risk injured children. Age-specific criteria should be considered for RR, heart rate, and SBP.
