Abstract 298: Development of a Pediatric Field Trauma Triage Algorithm for Identifying Children With Serious Injuries or Need for Major Surgical Intervention
Introduction: The American College of Surgeons Committee on Trauma (ACSCOT) triage criteria were developed primarily for adult triage and may not adequately identify seriously injured children.
Hypothesis: A practical, pediatric-specific field decision rule will better identify high-risk injured children compared to the ACSCOT criteria.
Methods: This was a population-based, retrospective cohort study of injured children 0–17 years evaluated by 42 EMS agencies transporting to 4 trauma centers and 40 community hospitals in 2 Northwest US regions between 1/2006 – 12/2008. All children with an EMS provider “primary impression” of injury or trauma were included, regardless of field transport or outcome. Variables included the 25 ACSCOT trauma triage criteria, age, gender, mechanism of injury, SBP, GCS, respiratory rate, and heart rate. Hospital outcome measures were probabilistically linked from 4 trauma registries and 2 state hospital discharge databases. We defined “high-risk” children (primary outcome) as having serious injury (Abbreviated Injury Scale score >= 3) or major non-orthopedic surgical intervention. We used 75% of the sample to derive the rule with classification and regression tree analysis, and the remaining 25% for validation.
Results: During the 3-year period, 22,078 injured children were evaluated by EMS personnel, of whom 13.5% were high-risk. The decision rule included (in order): EMS provider judgment, GCS <= 14, ventilation assistance, mechanism (penetrating injury, high energy, fall, pedestrian vs auto, concerning MVC), abnormal physical exam (proximal skeletal fracture, amputation, paralysis, head trauma, heart rate < 100 beats/minute) or age < 5 years. Sensitivity and specificity for identifying high-risk children were 91.1% (95%CI 87.3–94.8%) and 14.6% (95%CI 12.9–16.3%); ACSCOT criteria yielded 34.0% and 89.9%, respectively. Using the new criteria at these sites would require 3,164 children annually to be re-routed to trauma centers.
Conclusions: Our pediatric-specific field decision scheme had greater ability to identify high-risk injured children compared to standard ACSCOT triage criteria, yet would require a larger volume of injured children to be transported to major trauma centers.
- © 2010 by American Heart Association, Inc.