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Pediatric trauma triage: A Pediatric Trauma Society Research Committee systematic review
Maria Carmen Mora1, Laura Veras, Rita V Burke
1From the Division of Pediatric Surgery, Department of Surgery (M.C.M., L.V., A.G.), University of Tennessee Health Science Center, Memphis, Tennessee; Department of Preventive Medicine (R.V.B.), Keck School of Medicine, University of Southern California, Los Angeles, California; Institute of Health and Equity, Department of Epidemiology (L.D.C., E.M.), Medical College of Wisconsin, Milwaukee, Wisconsin; Cohen Children's Medical Center (N.C.), New Hyde Park, New York; Division of Pediatric Surgery (A.C., M.J.), Doernbecher Children's Hospital, Oregon Health and Science University; Division of Pediatric Surgery (A.C., M.J.), Randall Children's Hospital, Legacy Emanuel Medical Center, Portland, Oregon; Wolfson Children's Hospital (K.L.), University of Florida, Jacksonville, Florida; Division of Pediatric Surgery (N.Y.), University of Calgary, Calgary, Alberta; Children's Foundation Research Institute (A.G.), Le Bonheur Children's Hospital, Memphis, Tennessee; and Health Sciences Library (L.W.), University of Tennessee Health Science Center, Memphis, Tennessee.
Insights
Prehospital trauma triage for children lacks evidence for mortality reduction. However, hospital trauma activation criteria, especially physiologic signs, effectively predict interventions and outcomes in pediatric trauma patients.
Area of Science:
- Pediatric Emergency Medicine
- Trauma Surgery
- Public Health
Background:
- Triage of injured children varies significantly, often relying on mechanism of injury or physiologic criteria.
- The predictive value of current pediatric trauma triage criteria for interventions, morbidity, and mortality is not well-established.
- Existing systems face challenges in consistently identifying critically injured children.
Purpose of the Study:
- To systematically review evidence on the effectiveness of prehospital trauma triage criteria and scoring systems in injured children.
- To evaluate whether trauma center activation criteria predict outcomes and the need for interventions.
- To identify existing secondary triage criteria for pediatric patient transfers.
Main Methods:
- A systematic review of literature from January 1990 to August 2019 was conducted.
- Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were followed.
- Qualitative analysis assessed 38 selected studies using the Methodological Index for Non-randomized Studies tool.
Main Results:
- Prehospital triage criteria and scoring systems showed limited ability to predict or reduce mortality in pediatric trauma.
- Selected physiologic parameters in prehospital settings may offer some predictive value.
- Hospital trauma activation criteria, particularly physiologic signs, effectively predict the need for interventions and identify higher-risk patients.
Conclusions:
- Current evidence is insufficient to support the utility of prehospital triage criteria for injured children.
- Physiology-based trauma system activation criteria are effective in stratifying injured children.
- Further research is needed for prehospital and secondary transfer triage protocols in pediatric trauma care.
Background:
Significant variability exists in the triage of injured children with most systems using mechanism of injury and/or physiologic criteria. It is not well established if existing triage criteria predict the need for intervention or impact morbidity and mortality. This study evaluated existing evidence for pediatric trauma triage. Questions defined a priori were as follows: (1) Do prehospital trauma triage criteria reduce mortality? (2) Do prehospital trauma scoring systems predict outcomes? (3) Do trauma center activation criteria predict outcomes? (4) Do trauma center activation criteria predict need for procedural or operative interventions? (5) Do trauma bay pediatric trauma scoring systems predict outcomes? (6) What secondary triage criteria for transfer of children exist?
Methods:
A structured, systematic review was conducted, and multiple databases were queried using search terms related to pediatric trauma triage. The literature search was limited to January 1990 to August 2019. Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) methodology was applied with the methodological index for nonrandomized studies tool used to assess the quality of included studies. Qualitative analysis was performed.
Results:
A total of 1,752 articles were screened, and 38 were included in the qualitative analysis. Twelve articles addressed questions 1 and 2, 21 articles addressed question 3 to 5, and five articles addressed question 6. Existing literature suggest that prehospital triage criteria or scoring systems do not predict or reduce mortality, although selected physiologic parameters may. In contrast, hospital trauma activation criteria can predict the need for procedures or surgical intervention and identify patients with higher mortality; again, physiologic signs are more predictive than mechanism of injury. Currently, no standardized secondary triage/transfer protocols exist.
Conclusion:
Evidence supporting the utility of prehospital triage criteria for injured children is insufficient, while physiology-based trauma system activation criteria do appropriately stratify injured children. The absence of strong evidence supports the need for further prehospital and secondary transfer triage-related research.
Level Of Evidence:
Systematic review study, level II.
