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Limitations of Blood Pressure Measurements in Pediatric Trauma Patients During Field Triage
Amy Frederick1, Jason Winslow2, Vinci Jones3
1Trauma, Good Samaritan University Hospital, West Islip, USA.
Insights
Emergency Medical Service providers documented blood pressure in 70.1% of pediatric trauma patients, but less frequently in younger children. These measurements did not meet new national guidelines for severe injury identification.
Area of Science:
- Pediatric Trauma Care
- Emergency Medical Services
- Clinical Triage Guidelines
Background:
- National field triage guidelines now recommend age-specific systolic blood pressure (SBP) for identifying severely injured children.
- Understanding the frequency of blood pressure documentation by Emergency Medical Service (EMS) providers is crucial.
Purpose of the Study:
- To determine the frequency of blood pressure documentation by EMS providers for pediatric trauma patients.
- To assess the role of blood pressure measurements in pediatric trauma triage decisions.
Main Methods:
- Retrospective review of pediatric trauma admissions arriving by EMS.
- Data collected from January 1, 2019, to December 31, 2022, at a level II pediatric trauma center.
- Analysis included 298 patient records aged 0-14 years.
Main Results:
- Blood pressure was documented in 70.1% of pediatric trauma cases.
- Blood pressure documentation was significantly lower in children aged 0-9 years compared to those aged = > 10 years (p <0.001).
- No children aged 0-9 had SBP meeting the < 70 mmHg + (2x age) criteria; two children aged = > 10 had SBP < 90 mmHg.
Conclusions:
- While many pediatric trauma patients had documented field blood pressure, younger children were less likely to have this measurement.
- Documented prehospital blood pressures in severely injured children did not consistently meet new high-risk criteria.
- Other prehospital factors, like mechanism of injury, likely influenced transport decisions to the trauma center.
Introduction:
Recent revisions of national field triage guidelines recommend the addition of age-specific systolic blood pressure (SBP) measurement for identifying the most severely injured children requiring transport to a trauma center. The purpose of this study was to determine the frequency in which blood pressures are documented by Emergency Medical Service (EMS) providers and the role this measurement has had, among other factors, in triage decisions.
Methods:
This is an exploratory descriptive study with a retrospective review from the trauma registry database of all pediatric trauma admissions that arrived by EMS at a level II pediatric trauma center from January 1, 2019 to December 31, 2022.
Results:
Two hundred ninety-eight patient records of patients aged 0 to 14 were included. EMS providers documented blood pressure in 70.1% of the total sample. A significant difference in the frequency of this documentation was seen between ages zero to nine and = > 10 years (χ2(1,298) = 28.98 p <0.001). No children ages zero to nine years had SBP of < 70 mmHg + (2x age in years) documented by EMS. There were two children aged = > 10 who had a documented SBP < 90 and 12 children with documented EMS heart rate > SBP.
Conclusion:
Many children transported by EMS in this hospital's catchment area did have a field blood pressure measurement documented, but the frequency was significantly less in younger-aged children. The blood pressure measurements of children determined to have severe injuries in the sample did not meet the inclusion criteria for high risk of serious injury by the newly established national guidelines. This suggests other prehospital criteria, such as mechanism of injury or visual cues, prompted EMS to transport these pediatric trauma patients to a regional trauma center for specialized care.
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