Ability of the Physiologic Criteria of the Field Triage Guidelines to Identify Children Who Need the Resources of a Trauma Center

Lerner, E. Brooke; Drendel, Amy L.; Cushman, Jeremy T.; Badawy, Mohamed; Shah, Manish N.; Guse, Clare E.; Cooper, Arthur

doi:10.1080/10903127.2016.1233311

Cited by 27 publications

(41 citation statements)

References 13 publications

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“…With regard to the use in children, the tool integrates adaption of physiological and amnestic criteria. However, in a recent retrospective study of trauma triage in children in the USA, the physiologic criteria showed only a moderate predictive capacity to appropriately determine a trauma center need for children [24]. Specific pediatric trauma scores facilitate the decision process for pediatric trauma patients.…”

Section: Discussionmentioning

confidence: 99%

Effect of under triage on early mortality after major pediatric trauma: a registry-based propensity score matching analysis

et al. 2021

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Background Little is known about the effect of under triage on early mortality in trauma in a pediatric population. Our objective is to describe the effect of under triage on 24-h mortality after major pediatric trauma in a regional trauma system. Methods This cohort study was conducted from January 2009 to December 2017. Data were obtained from the registry of the Northern French Alps Trauma System. The network guidelines triage pediatric trauma patients according to an algorithm shared with adult patients. Under triage was defined by the number of pediatric trauma patients that required specialized trauma care transported to a non-level I pediatric trauma center on the total number of injured patients with critical resource use. The effect of under triage on 24-h mortality was assessed with inverse probability treatment weighting (IPTW) and a propensity score (Ps) matching analysis. Results A total of 1143 pediatric patients were included (mean [SD], age 10 [5] years), mainly after a blunt trauma (1130 [99%]). Of the children, 402 (35%) had an ISS higher than 15 and 547 (48%) required specialized trauma care. Nineteen (1.7%) patients died within 24 h. Under triage rate was 33% based on the need of specialized trauma care. Under triage of children requiring specialized trauma care increased the risk of death in IPTW (risk difference 6.0 [95% CI 1.3–10.7]) and Ps matching analyses (risk difference 3.1 [95% CI 0.8–5.4]). Conclusions In a regional inclusive trauma system, under triage increased the risk of early death after pediatric major trauma.

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Section: Discussionmentioning

confidence: 99%

Effect of under triage on early mortality after major pediatric trauma: a registry-based propensity score matching analysis

et al. 2021

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“…It could be suggested that an incomplete triage could jeopardise patient safety and thus omit significant abnormal vital signs. However, previous studies have shown that VS are only moderate predictors when assessing children in need of a trauma centre [ 43 ] and, furthermore, that there is a correlation between the degree of acuity level and the number of VS that were registered [ 44 ]. Even though measuring VS in the EMS care of injured and sick children has been emphasised to reduce under-triage [ 45 , 46 ], implementing VS in all the patients in the MTS for paediatrics did not improve performance [ 47 ].…”

Section: Discussionmentioning

confidence: 99%

Initial assessment, level of care and outcome among children who were seen by emergency medical services: a prospective observational study

Magnusson

Herlitz

Karlsson

et al. 2018

Scand J Trauma Resusc Emerg Med

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BackgroundThe assessment of children in the Emergency Medical Service (EMS) is infrequent representing 5.4% of the patients in an urban area in the western part of Sweden. In Sweden, patients are assessed on scene by an EMS nurse whom independently decides on interventions and level of care. To aid the EMS nurse in the assessment a triage instrument, Rapid Emergency Triage and Treatment System-paediatrics (RETTS-p) developed for Emergency Department (ED) purpose has been in use the last 5 years. The aim of this study was to evaluate the EMS nurse assessment, management, the utilisation of RETTS-p and patient outcome.MethodsA prospective, observational study was performed on 651 children aged < 16 years from January to December 2016. Statistical tests used in the study were Mann-Whitney U test, Fisher’s exact test and Spearman’s rank statistics.ResultsThe dispatch centre indexed life-threatening priority in 69% of the missions but, of all children, only 6.1% were given a life threatening RETTS-p red colour by the EMS nurse. A total of 69.7% of the children were transported to the ED and, of these, 31.7% were discharged without any interventions. Among the non-conveyed patients, 16 of 197 (8.1%) visited the ED within 72 h but only two were hospitalised. Full triage, including five out of five vital signs measurements and an emergency severity index, was conducted in 37.6% of all children. A triage colour was not present in 146 children (22.4%), of which the majority were non-conveyed. The overall 30-day mortality rate was 0.8% (n = 5) in children 0–15 years.ConclusionsDespite the incomplete use of all vital signs according to the RETTS-p, the EMS nurse assessment of children appears to be adapted to the clinical situation in most cases and the patients appear to be assessed to the appropriate level of care but indicating an over triage. It seems that the RETTS-p with full triage is used selectively in the pre-hospital assessment of children with a risk of death during the first 30 days of less than 1%.

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“…However, in a recent retrospective study of trauma triage in children in the US, the physiologic criteria showed only a moderate predictive capacity to appropriately determine a trauma center need for children. (23) Speci c pediatric trauma scores facilitate the decision process for pediatric trauma patients. For example, the pediatric trauma score was developed to predict injury severity and mortality after pediatric major trauma.…”

Section: Discussionmentioning

confidence: 99%

Effect of Under Triage on Early Mortality After Major Pediatric Trauma: A Registry-based Propensity Score Matching Analysis

Ageron

Porteaud

Evain

et al. 2020

Preprint

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Backgroundlittle is known about the effect of under triage on early mortality in trauma in a pediatric population. Our objective is to describe the effect of under triage on 24 hour-mortality after major pediatric trauma in a regional trauma systemMethodsThis cohort study was conducted from January 2009 to December 2017. Data were obtained from the registry of the Northern French Alps Trauma System. The network guidelines triage pediatric trauma patients according to an algorithm shared with adult patients. Under triage was defined by the number of pediatric trauma patients that required specialized trauma care transported to a non-level I pediatric trauma center on the total number of injured patients with critical resource use. The effect of under triage on 24 hour-mortality was assessed with inverse probability treatment weighting (IPTW) and a propensity score (Ps) matching analysis. ResultsA total of 1 143 pediatric patients were included (mean [SD], age 10 [5] years), mainly after a blunt trauma (1130 [99%]). Of the children, 402 (35%) had an ISS higher than 15 and 547 (48%) required specialized trauma care. Nineteen (1.7%) patients died within 24 hours. Under triage rate was 33% based on the need of specialized trauma care. Under triage of children requiring specialized trauma care increased the risk of death in IPTW (risk difference: 6.0 [95% CI 1.3-10.7]) and Ps matching analyses (risk difference: 3.1 [95% CI 0.8-5.4]).ConclusionsIn a regional inclusive trauma system, under triage increased the risk of early death after pediatric major trauma.

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Ability of the Physiologic Criteria of the Field Triage Guidelines to Identify Children Who Need the Resources of a Trauma Center

Abstract: The Physiologic Criteria are a moderate predictor of trauma center need for children. Missing or inaccurate vital signs may be limiting the predictive value of the Physiologic Criteria.

Cited by 27 publications

References 13 publications

Effect of under triage on early mortality after major pediatric trauma: a registry-based propensity score matching analysis

Effect of under triage on early mortality after major pediatric trauma: a registry-based propensity score matching analysis

Initial assessment, level of care and outcome among children who were seen by emergency medical services: a prospective observational study

Effect of Under Triage on Early Mortality After Major Pediatric Trauma: A Registry-based Propensity Score Matching Analysis

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