Expert Perspectives on Time Sensitivity and a Related Metric for Children Involved in Motor Vehicle Crashes
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Published on: June 9, 2020
Andrea N Doud1, Samantha L Schoell2, Ashley A Weaver2
1Wake Forest School of Medicine, Winston-Salem, NC; Childress Institute for Pediatric Trauma, Winston-Salem, NC.
Insights
Advanced Automatic Crash Notification (AACN) systems need better pediatric injury assessment. This study developed a time sensitivity (TS) score, showing age-specific injury needs differ from standard Abbreviated Injury Scale (AIS) metrics.
Area of Science:
- Trauma research
- Pediatric emergency medicine
- Injury biomechanics
Background:
- Advanced Automatic Crash Notification (AACN) systems utilize vehicle telemetry to predict serious injury risk in motor vehicle crashes.
- Accurate triage of injured children by first responders can be improved by AACN systems.
- Current AACN systems often rely on Abbreviated Injury Scale (AIS) metrics, which may not fully capture age-specific injury severity for pediatric populations.
Purpose of the Study:
- To develop an age-specific approach for defining serious injury in children for AACN systems.
- To create a Time Sensitivity (TS) score that evaluates injury severity, urgency, and predictability in pediatric motor vehicle crash occupants.
- To outline the development and validation of this novel TS score.
Main Methods:
- Analysis of a national motor vehicle crash dataset (2000-2011) to identify the 95% most frequent AIS 2+ injuries across pediatric age groups (0-4, 5-9, 10-14, 15-18 years).
- Expert clinician review of age-specific injuries to determine trauma center necessity and treatment urgency.
- Calculation of a TS score (0-1) based on mean trauma center decision and urgency ratings.
Main Results:
- A total of 30-32 expert responses were obtained per injury.
- Younger children's injuries received significantly higher median TS scores (0-4 years: 0.89, 5-9 years: 0.87) compared to older children (10-14 years: 0.82, 15-18 years: 0.72).
- Significant variation in TS was observed within AIS severity levels, highlighting limitations of AIS alone (e.g., AIS 2 injuries in 0-4 year olds ranged from 0.12 to 0.98).
Conclusions:
- The Time Sensitivity (TS) of pediatric injuries is age-dependent and not fully represented by current Abbreviated Injury Scale (AIS) metrics.
- AACN systems may require age-specific injury data beyond AIS to accurately assess and triage injured children.
- The developed TS score offers a more nuanced approach to evaluating pediatric injury severity for improved crash notification systems.
Objective:
Advanced Automatic Crash Notification (AACN) uses vehicle telemetry data to predict risk of serious injury among motor vehicle crash occupants and can thus improve the accuracy with which injured children are triaged by first responders. To better define serious injury for AACN systems (which typically use Abbreviated Injury Scale [AIS] metrics), an age-specific approach evaluating severity, time sensitivity (TS), and predictability of injury has been developed. This study outlines the development of the TS score.
Methods:
The 95% most frequent AIS 2+ injuries in a national motor vehicle crash data set spanning 2000 to 2011 were determined for the following age groups: 0 to 4, 5 to 9, 10 to 14, and 15 to 18 years. For each age-specific injury, clinicians with pediatric trauma expertise were asked if treatment at a trauma center was required and were asked about the urgency of treatment. A TS score (range 0-1) was calculated by combining the mean trauma center decision and urgency scores.
Results:
A total of 30 to 32 responses were obtained for each age-specific injury. The most frequent motor vehicle crash-induced injuries in the younger groups received significantly higher scores than those in the older groups (median TS score 0 to 4 years: 0.89, 5-9 years: 0.87, 10-14 years: 0.82, 15-18 years: 0.72, P < .001). Large variations in TS existed within each AIS severity level; for example, scores among AIS 2 injuries in 0- to 4-year-olds ranged from 0.12 to 0.98.
Conclusions:
The TS of common pediatric injuries varies on the basis of age and may not be accurately reflected by AIS metrics. AIS may not capture all aspects of injury that should be considered by AACN systems.
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