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Does Mechanism of Injury Predict Trauma Center Need for Children?
Insights
The Mechanism of Injury Criteria in the Field Triage Decision Scheme (FTDS) is inaccurate for identifying pediatric trauma patients, leading to a 77% under-triage rate. Further research is needed to improve this critical tool for emergency medical services (EMS).
Area of Science:
- Emergency Medicine
- Pediatric Trauma Care
- Public Health
Background:
- The Field Triage Decision Scheme (FTDS) is a crucial tool for emergency medical services (EMS) to identify injured children requiring trauma center resources.
- Accurate triage is essential to ensure timely and appropriate care for critically injured pediatric patients.
Purpose of the Study:
- To evaluate the accuracy of the Mechanism of Injury Criteria within the FTDS for identifying children who need specialized trauma center resources.
- To determine the under-triage rate associated with the Mechanism of Injury Criteria in pediatric trauma cases.
Main Methods:
- A prospective study interviewed EMS providers transporting injured children (≤15 years) to pediatric trauma centers over three years.
- Data included EMS-observed physiology, suspected injuries, and mechanism of injury, linked to hospital records to determine need for trauma center resources based on a consensus definition.
- Statistical analysis included positive likelihood ratios (+LR) and 95% confidence intervals (95%CI).
Main Results:
- Of 7,911 analyzed cases, 62 children required trauma center resources.
- The Mechanism of Injury Criteria identified only 14 of these children, resulting in a 77% under-triage rate.
- Mechanisms not listed in the FTDS, such as sports-related injuries and assault, accounted for a significant portion of under-triaged patients.
Conclusions:
- The current Mechanism of Injury Criteria in the FTDS is insufficient for accurately identifying all children needing trauma center care.
- A substantial proportion of pediatric trauma mechanisms are not covered by the FTDS, and the criteria do not significantly improve identification rates.
- Improvements to the FTDS are necessary to enhance EMS providers' ability to identify children requiring trauma center resources.
Objective:
To determine if the Mechanism of Injury Criteria of the Field Triage Decision Scheme (FTDS) are accurate for identifying children who need the resources of a trauma center.
Methods:
EMS providers transporting any injured child ≤15 years, regardless of severity, to a pediatric trauma center in 3 midsized communities over 3 years were interviewed. Data collected through the interview included EMS observed physiologic condition, suspected anatomic injuries, and mechanism. Patients were then followed to determine if they needed the resources of a trauma center by reviewing their medical record after hospital discharge. Patients were considered to need a trauma center if they received an intervention included in a previously published consensus definition. Data were analyzed with descriptive statistics including positive likelihood ratios (+LR) and 95% confidence intervals (95%CI).
Results:
9,483 provider interviews were conducted and linked to hospital outcome data. Of those, 230 (2.4%) met the consensus definition for needing a trauma center. 1,572 enrolled patients were excluded from further analysis because they met the Physiologic or Anatomic Criteria of the FTDS. Of the remaining 7,911 cases, 62 met the consensus definition for needing a trauma center (TC). Taken as a whole, the Mechanism of Injury Criteria of the FTDS identified 14 of the remaining 62 children who needed the resources of a trauma center for a 77% under-triage rate. The mechanisms sustained were 36% fall (16 needed TC), 28% motor vehicle crash (MVC) (20 needed TC), 7% struck by a vehicle (10 needed TC), <1% motorcycle crash (none needed TC), and 29% had a mechanism not included in the FTDS (16 needed TC). Of those who sustained a mechanisms not listed in the FTDS, the most common mechanisms were sport related injuries not including falls (24% of 2,283 cases with a mechanism not included) and assault (13%). Among those who fell from a height greater than 10 feet, 4 needed a TC (+LR 5.9; 95%CI 2.8-12.6). Among those in a MVC, 41 were reported to have been ejected and none needed a TC, while 31 had reported meeting the intrusion criteria and 0 needed a TC. There were 32 reported as having a death in the same vehicle, and 2 needed a TC (+LR 7.42; 95%CI: 1.90-29.0).
Conclusion:
Over a quarter of the children who needed the resources of a trauma center were not identified using the Physiologic or Anatomic Criteria of the Field Triage Decision Scheme. The Mechanism of Injury Criteria did not apply to over a quarter of the mechanisms experienced by children transported by EMS for injury. Use of the Mechanism Criteria did not greatly enhance identification of children who need a trauma center. More work is needed to improve the tool used to assist EMS providers in the identification of children who need the resources of a trauma center.
