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Independent application of the Sacco Disaster Triage Method to pediatric trauma patients
1Department of Pediatrics, Kosair Children's Hospital, University of Louisville, Kentucky 40202, USA. keith.cross@louisville.edu
Insights
The Sacco Triage Method accurately predicts mortality in pediatric trauma patients, demonstrating its validity for prioritizing injured children. This validated method improves emergency response for young victims.
Area of Science:
- Emergency Medicine
- Trauma Surgery
- Pediatric Critical Care
Background:
- Existing mass-casualty triage methods lack robust evidence-based validation.
- The Sacco Triage Method (STM) has proven effective for adult trauma stratification.
- Validation of the STM for pediatric populations is currently lacking.
Purpose of the Study:
- To evaluate the performance and accuracy of the Sacco Triage Method (STM) in pediatric trauma victims.
- To determine the predictive capability of the STM for mortality in children.
Main Methods:
- Analysis of pediatric trauma records (≤18 years) from the National Trauma Data Base (2007-2009).
- Assignment of Sacco triage scores and development of receiver-operator curves to predict mortality.
- Calculation of Area Under the Curve (AUC) as the primary outcome statistic, with sensitivity analyses.
Main Results:
- The STM with age adjustment achieved an AUC of 0.933 for predicting pediatric trauma mortality.
- The method demonstrated high accuracy for both blunt (AUC: 0.938) and penetrating trauma (AUC: 0.927).
- Accuracy remained consistent across different age groups and for secondary outcomes like major injury.
Conclusions:
- The Sacco Triage Method is a highly accurate predictor of mortality in pediatric trauma patients.
- The STM, with or without age adjustment, is a validated and effective triage strategy for injured children.
- This method supports improved prioritization and management of pediatric trauma cases.
Introduction:
Though many mass-casualty triage methods have been proposed, few have been validated in an evidence-based manner. The Sacco Triage Method (STM) has been shown to accurately stratify adult victims of blunt and penetrating trauma into groups of increasing mortality risk. However, it has not been validated for pediatric trauma victims.
Purpose:
Evaluate the STM's performance in pediatric trauma victims.
Methods:
Records from the United States' National Trauma Data Base, a registry of trauma victims developed by the American College of Surgeons, were extracted for the 2007-2009 reporting years. Patients ≤ 18 years of age transported from a trauma scene with complete initial scene data were included in the analysis. Sacco triage scores were assigned to each registry patient, and receiver-operator curves were developed for predicting mortality, along with several secondary outcomes. Area under the receiver-operator curve (AUC) was the main outcome statistic. Sensitivity analysis was performed using a Sacco score without age adjustment, using blunt versus penetrating trauma, and using patients <12 years of age.
Results:
There were 210,175 pediatric records, of which 90,037 had complete data for analysis. The STM with age adjustment predicted pediatric trauma mortality with an AUC of 0.933 (95% CI: 0.925-0.940). Without the age adjustment term, it predicted mortality with an AUC of 0.924 (95% CI: 0.916-0.933). The STM with age adjustment predicted blunt trauma mortality in 72,467 patients with an AUC of 0.938 (95% CI: 0.929-0.947) and penetrating trauma mortality in 10,099 patients with an AUC of 0.927 (95% CI: 0.911-0.943). These findings did not change significantly when analysis was limited to patients <12 years of age. The Sacco Triage Method was also predictive of some secondary outcomes, such as major injury and death on arrival to the emergency department.
Conclusion:
The Sacco Triage Method, with or without its age adjustment term, was a highly accurate predictor of mortality in pediatric trauma patients in this registry database. This triage method appears to be a valid strategy for the prioritization of injured children.
