Related Experiment Video
Updated: Aug 8, 2025
A Pediatric Concussion Model in Mice: Closed Head Injury with Long-Term Disorders (CHILD)
Published on: February 7, 2025
Evaluation of activation criteria in paediatric multi-trauma
Neta Cohen1, Adrienne L Davis1, Gidon Test1
1Division of Paediatric Emergency Medicine, Department of Paediatrics, SickKids, University of Toronto, Toronto, Ontario, Canada.
Insights
Optimizing trauma activation criteria for pediatric multi-trauma patients, including Glasgow Coma Scale (GCS) <14, can reduce over- and under-triage. This study identifies key predictors for acute care needs in children.
Area of Science:
- Pediatric Trauma Care
- Emergency Medicine
- Clinical Outcomes Research
Background:
- Accurate trauma activation criteria are crucial for timely pediatric multi-trauma care.
- Existing criteria may lead to over- or under-triage, impacting resource allocation and patient outcomes.
- The optimal set of criteria, particularly the Glasgow Coma Scale (GCS) cut-off, requires further investigation.
Purpose of the Study:
- To identify the optimal trauma activation criteria for predicting acute care needs in pediatric multi-trauma patients.
- To evaluate the predictive value of the Glasgow Coma Scale (GCS) and other clinical factors.
- To assess the impact of revised criteria on over- and under-triage rates.
Main Methods:
- Retrospective cohort study of pediatric multi-trauma patients (0-16 years) at a Level 1 trauma center.
- Analysis of trauma activation criteria and GCS levels against need for acute care (OR disposition, ICU admission, trauma room interventions, in-hospital death).
- Statistical analysis using adjusted odds ratios (aOR) and confidence intervals (CI).
Main Results:
- A set of criteria including GCS <14, hemodynamic instability, open pneumothorax/flail chest, spinal cord injury, pre-hospital blood transfusion, and GSW to specific body regions predicted acute care needs.
- GCS <14 showed a significant association (aOR 23.0, P < 0.001).
- Implementing these criteria could reduce over-triage by 10.7% and under-triage by 1.3%.
Conclusions:
- The proposed set of trauma activation criteria, including GCS <14, can improve triage accuracy in pediatric multi-trauma.
- These criteria have the potential to decrease both over- and under-triage rates.
- Prospective studies are recommended to validate these findings in pediatric populations.
Objective:
To explore the optimal set of trauma activation criteria predicting paediatric patients' need for acute care following multi-trauma, with particular attention to Glasgow Coma Scale (GCS) cut-off value.
Methods:
A retrospective cohort study of paediatric multi-trauma patients aged 0 to 16 years, performed at a Level 1 paediatric trauma centre. Trauma activation criteria and GCS levels were examined with respect to patients' need for acute care, defined as: direct to operating room disposition, intensive care unit admission, need for acute interventions in the trauma room, or in-hospital death.
Results:
We enrolled 436 patients (median age 8.0 years). The following predicted need for acute care: GCS <14 (adjusted odds ratio [aOR] 23.0, 95% confidence interval [CI]: 11.5 to 45.9, P < 0.001), hemodynamic instability: (aOR 3.7, 95% CI: 1.2-8.1, P = 0.01), open pneumothorax/flail chest (aOR: 20.0, 95% CI: 4.0 to 98.7, P < 0.001), spinal cord injury (aOR 15.4, 95% CI; 2.4 to 97.1, P = 0.003), blood transfusion at the referring hospital (aOR: 7.7, 95% CI: 1.3 to 44.2, P = 0.02) and GSW to the chest, abdomen, neck, or proximal extremities (aOR 11.0, 95% CI; 1.7 to 70.8, P = 0.01). Using these activation criteria would have decreased over- triage by 10.7%, from 49.1% to 37.2% and under-triage by 1.3%, from 4.7% to 3.5%, in our cohort of patients.
Conclusions:
Using GCS<14, hemodynamic instability, open pneumothorax/flail chest, spinal cord injury, blood transfusion at the referring hospital, and GSW to the chest, abdomen, neck of proximal extremities, as T1 activation criteria could decrease over- and under-triage rates. Prospective studies are needed to validate the optimal set of activation criteria in paediatric patients.
