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Introduction of Pediatric Physiological and Anatomical Triage Score in Mass-Casualty Incident

Chiaki Toida1, Takashi Muguruma1, Takeru Abe1

  • 1Department of Emergency Medicine,Yokohama City University Graduate School of Medicine,Yokohama,Japan.

Prehospital and Disaster Medicine
|February 13, 2018
PubMed

Insights

A new Pediatric Physiological and Anatomical Triage Score (PPATS) offers superior accuracy for secondary triage in pediatric mass-casualty incidents. This method effectively identifies children needing intensive care, outperforming existing triage tools.

Area of Science:

  • Emergency Medicine
  • Pediatric Critical Care
  • Disaster Medicine

Background:

  • Effective triage is crucial for managing mass-casualty incidents, yet lacks specific pediatric secondary triage tools.
  • Current methods may not adequately address the unique physiological needs of children in disaster scenarios.

Purpose of the Study:

  • To develop and validate a novel secondary triage method for pediatric patients in mass-casualty incidents.
  • To compare the accuracy of the new Pediatric Physiological and Anatomical Triage Score (PPATS) against existing triage systems.

Main Methods:

  • Retrospective chart review of pediatric patients (<16 years) admitted to an emergency center (2014-2016).
  • Development of PPATS and definition of intensive care unit (ICU)-indicated patients.
  • Comparative analysis of PPATS, Physiological and Anatomical Triage (PAT), and Triage Revised Trauma Score (TRTS) for predicting ICU admission.

Main Results:

  • PPATS demonstrated superior accuracy in predicting ICU-indicated patients compared to PAT and TRTS (AUC 0.95 vs. 0.65 and 0.79).
  • The optimal PPATS cut-off (six) achieved high sensitivity (95.8%) and specificity (86.7%), with excellent negative predictive value (99.0%).
  • PPATS showed significant associations with predicted mortality, ventilation time, and ICU/hospital length of stay.

Conclusions:

  • The Pediatric Physiological and Anatomical Triage Score (PPATS) is a highly accurate and reliable tool for secondary triage of children in mass-casualty incidents.
  • PPATS surpasses existing methods in identifying pediatric patients requiring intensive care, improving disaster response efficacy.
  • This validated score can enhance clinical decision-making and resource allocation in pediatric mass-casualty scenarios.
Abstract

Keywords:
AUC area under the receiver-operating characteristic curveGCS Glasgow Coma ScoreHR heart rateICU intensive care unitNPV negative predictive valuePAT Physiological and Anatomical TriagePPATS Pediatric Physiological and Anatomical Triage ScorePPV positive predictive valueRR respiratory rateSTART Simple Triage and Rapid TreatmentTRTS Triage Revised Trauma ScoresBP systolic blood pressurecritically ill childrenmass-casualty incidentphysiological and anatomical triagesecondary triagetriage revised trauma score

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