A multicenter prospective analysis of pediatric trauma activation criteria routinely used in addition to the six criteria of the American College of Surgeons

Falcone, Richard A.; Haas, Lynn; King, Eileen; Moody, Suzanne; Crow, John P.; Moss, Ann; Gaines, Barbara A.; McKenna, Christine; Gourlay, David M.; Werner, C.; Meagher, David P.; Schwing, Lisa; Garcia, Nilda M.; Brown, Deb; Groner, Judith A.; Haley, Kathy; DeRoss, Anthony L.; Cizmar, Laura; Armola, Rochelle

doi:10.1097/ta.0b013e318259ca84

Cited by 42 publications

(28 citation statements)

References 25 publications

(25 reference statements)

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“…The Centers for Disease Control and Prevention reports that trauma is a leading cause of death for individuals 1-44 years of age. It is estimated that 10-15% of children hospitalized after trauma have life-threatening injuries that demand an expedient and systematic approach to their care (1). Packed RBC (PRBC) transfusions to critically injured patients are considered life-saving therapy, especially when administered in response to hemodynamic instability after hemorrhage.…”

mentioning

confidence: 99%

RBC Transfusions in Children Requiring Intensive Care Admission After Traumatic Injury*

Hassan

DeCou

Reischman

et al. 2014

Pediatric Critical Care Medicine

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mentioning

confidence: 99%

RBC Transfusions in Children Requiring Intensive Care Admission After Traumatic Injury*

Hassan

DeCou

Reischman

et al. 2014

Pediatric Critical Care Medicine

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“…*Percentages are rounded and do not always add to 100%.†ISS calculated on 603 patients with legitimate ISS scores (patients with documented injuries such as blunt, penetrating and burn injuries).FI, Falcone Interventions19; ICU, intensive care unit; ISS, Injury Severity Score; LOS, length of stay; TTA, trauma team activation.…”

Section: Resultsmentioning

confidence: 99%

“…FI, Falcone Interventions19; ICU, intensive care unit; ISS, Injury Severity Score; LOS, length of stay; TTA, trauma team activation.…”

Section: Resultsmentioning

confidence: 99%

“…An expert consensus list of high-level trauma resuscitation resources has recently been used by Falcone et al 19 to assess the performance of different TTA criteria (box 1 ) . This list was developed using a Delphi method of prioritisation from a panel of paediatric trauma directors and trauma programme managers in the USA, focusing on the use of ED resources believed to justify the need for TTA.…”

Section: Introductionmentioning

confidence: 99%

“…This study aimed to determine which of the two outcome measures would be a better standard for assessing appropriateness of TTA at a paediatric centre—major trauma classification (as currently used at our institution) or the use of ED resources as defined by Falcone et al 19. We hypothesised that the latter would be a more clinically relevant measure to assess appropriateness of TTA, as it focuses on the acute resuscitation care for which the trauma team is assembled, rather than on a retrospective classification that may not necessarily reflect the initial resuscitation requirements.…”

Section: Introductionmentioning

confidence: 99%

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Establishing a standard for assessing the appropriateness of trauma team activation: a retrospective evaluation of two outcome measures

et al. 2014

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Comparison of Vital Sign Cutoffs to Identify Children With Major Trauma

Gorski,

Chaudhari,

Spurrier

et al. 2024

JAMA Netw Open

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ImportanceVital signs are essential components in the triage of injured children. The Advanced Trauma Life Support (ATLS) and Pediatric Advanced Life Support (PALS) physiologic criteria are frequently used for trauma assessments.ObjectiveTo evaluate the performance of ATLS and PALS criteria vs empirically derived criteria for identifying major trauma in children.Design, Setting, and ParticipantsThis retrospective cohort study used 2021 American College of Surgeons Trauma Quality Improvement Program (TQIP) data contributed by US trauma centers. Included encounters involved pediatric patients (aged &lt;18 years) with severe injury, excluding those who experienced out-of-hospital cardiac arrest, were receiving mechanical ventilation, or were transferred from another facility. Data were analyzed between April 9 and December 21, 2023.ExposureInitial hospital vital signs, including heart rate, respiratory rate, and systolic blood pressure (SBP).Main Outcome and MeasuresMajor trauma, determined by the Standard Triage Assessment Tool, a composite measure of injury severity and interventions performed. Multivariable models developed from PALS and ATLS vital sign criteria were compared with models developed from the empirically derived criteria using the area under the receiver operating characteristic curve. Validation of the findings was performed using the 2019 TQIP dataset.ResultsA total of 70 748 patients (median [IQR] age, 11 [5-15] years; 63.4% male) were included, of whom 3223 (4.6%) had major trauma. The PALS criteria classified 31.0% of heart rates, 25.7% of respiratory rates, and 57.4% of SBPs as abnormal. The ATLS criteria classified 25.3% of heart rates, 4.3% of respiratory rates, and 1.1% of SBPs as abnormal. Among children with all 3 vital signs documented (64 326 [90.9%]), PALS had a sensitivity of 88.4% (95% CI, 87.1%-89.3%) and specificity of 25.1% (95% CI, 24.7%-25.4%) for identifying major trauma, and ATLS had a sensitivity of 54.5% (95% CI, 52.7%-56.2%) and specificity of 72.9% (95% CI, 72.6%-73.3%). The empirically derived cutoff vital sign z scores had a sensitivity of 80.0% (95% CI, 78.5%-81.3%) and specificity of 48.7% (95% CI, 48.3%-49.1%) and area under the receiver operating characteristic curve of 70.9% (95% CI, 69.9%-71.8%), which was similar to PALS criteria (69.6%; 95% CI, 68.6%-70.6%) and greater than ATLS criteria (65.4%; 95% CI, 64.4%-66.3%). Validation using the 2019 TQIP database showed similar performance to the derivation sample.Conclusions and RelevanceThese findings suggest that empirically derived vital sign criteria strike a balance between the sensitivity of PALS criteria and the specificity of ATLS criteria in identifying major trauma in children. These criteria may help to identify children at greatest risk of trauma-related morbidity and mortality.

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A multicenter prospective analysis of pediatric trauma activation criteria routinely used in addition to the six criteria of the American College of Surgeons

Abstract: The ACS-6 provides a reliable overtriage or undertriage rate for pediatric patients. The inclusion of two additional criteria can further improve these rates while maintianing a simplified triage list for children.

Cited by 42 publications

References 25 publications

RBC Transfusions in Children Requiring Intensive Care Admission After Traumatic Injury*

RBC Transfusions in Children Requiring Intensive Care Admission After Traumatic Injury*

Establishing a standard for assessing the appropriateness of trauma team activation: a retrospective evaluation of two outcome measures

Comparison of Vital Sign Cutoffs to Identify Children With Major Trauma

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