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Pediatric trauma triage: review of 1,307 cases
R A Jubelirer1, N N Agarwal, F C Beyer
1Abington Memorial Hospital, PA.
Insights
Pediatric trauma triage at Level II Trauma Centers shows that children with a Pediatric Trauma Score (PTS) over 8, requiring intensive care unit (ICU) or with altered consciousness, can be safely treated locally.
Area of Science:
- Pediatric Trauma Care
- Emergency Medicine
- Surgical Critical Care
Background:
- Pediatric trauma centers are crucial for managing severe injuries in children.
- Optimal triage and transfer protocols ensure timely access to specialized care.
- Understanding current practices informs improvements in pediatric trauma management.
Purpose of the Study:
- To evaluate pediatric trauma triage and patient transfer patterns.
- To assess the appropriateness of care for pediatric trauma patients at Level II Trauma Centers.
- To compare current practices with American College of Surgeons guidelines for transfer to Level I centers.
Main Methods:
- Retrospective review of 1,307 pediatric trauma patients (≤14 years) admitted or deceased during resuscitation.
- Data collected from eight Level II Trauma Centers between January 1987 and December 1988.
- Analysis included age, diagnosis, injury mechanism, Pediatric Trauma Score (PTS), ICU and hospital length of stay, and outcomes.
Main Results:
- Of 1,264 patients not transferred, the average age was 8.34 years, average PTS was 9.74, and average hospital stay was 4.46 days.
- 19.7% required intensive care unit (ICU) care for an average of 2.86 days.
- 24 patients (1.8%) died, all with a PTS ≤ 8. Children with PTS > 8 needing ICU care or with altered consciousness could be safely treated at Level II centers.
Conclusions:
- Current pediatric trauma triage at Level II centers may not always align with transfer guidelines.
- Children with a PTS > 8 requiring ICU care or with altered consciousness can be safely managed in adult ICUs at Level II Trauma Centers.
- This suggests that Level II centers can effectively manage a significant proportion of pediatric trauma patients, potentially reducing unnecessary transfers.
Abstract:
To assess patterns of pediatric trauma triage and patient transfer to the pediatric trauma centers, the records of 1,307 patients 14 years old or less who were admitted or died during resuscitation at eight Level II Trauma Centers from January 1987 through December 1988 were reviewed retrospectively. Cases were analyzed according to the following criteria: age, diagnosis, mechanism of injury, admitting service, pediatric trauma score (PTS), length of stay in the intensive care unit (ICU) and in the hospital, and outcome. Forty-three patients were transferred to pediatric trauma centers based on local criteria. Of the remaining 1,264 patients kept at the Level II Trauma Centers, the average patient age was 8.34 year; PTS, 9.74; and length of stay, 4.46 days. Two hundred fifty-eight patients (19.7%) required ICU care for an average length of stay of 2.86 days. Twenty-four patients (1.8%) died; all 24 had a PTS less than or equal to 8. In comparing the data to the guidelines in Appendix J of the American College of Surgeons' Hospital and Prehospital Resources for Optimal Trauma Care of the Injured Patient for transfer to a Level I Pediatric Trauma Center, we found that children with a PTS greater than 8 and who either require ICU care and/or have altered states of consciousness can safely be treated in the adult ICU of a Level II Trauma Center.