Accuracy of Pediatric Trauma Field Triage

Abstract

It is crucial to transport the right patient to the right hospital. Yet the quality of the full diagnostic strategy to determine the optimal receiving hospital is unknown. None of the investigated field triage protocols complied with current sensitivity targets. Improved efforts are needed to develop accurate child-specific tools to prevent undertriage and its potential life-threatening consequences.

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

“…In a recent review including five studies with a combined number of 1222 pediatric patients requiring specialized trauma care, the sensitivity of the prehospital triage tools ranged from 49.1 to 87.3% to correctly identify pediatric major trauma patients. This corresponded to under triage rates between 12.7 and 50.9% [10]. An under triage higher than 20% was also reported in the Western USA between 2006 and 2008 for children 0 to 10 years of age and 11 to 20 years of age with a major trauma (ISS > 15) [17].…”

“…It seems that high under triage rates are common in the pediatric population in diverse settings [19]. In fact, several studies reported unacceptable under triage rates even when using specific pediatric algorithms [10]. These observations seem to mirror the complexities of the triage process itself between the constraints of the triage tool, prehospital provider experience and judgement, and trauma center proximity and capacity [20].…”

“…The pediatric trauma triage checklist was supposed to make the pediatric trauma score more "user friendly" and in consequence implemented in many trauma centers in the USA [27]. Unfortunately, a recent systematic review could not demonstrate a reduction in under triage based on this tool [10]. Triage of children after major trauma remains challenging, and a high proportion of injured children is currently misclassified by existing triage protocols resulting in potential deleterious effect on mortality.…”

“…Major trauma patients are usually defined by an ISS > 15 [15]. Since ISS predicts mainly mortality [13], several studies rely on the need of early critical resource use to assess triage accuracy [10]. In our study, trauma severity was defined by the need of specialized trauma care such as pediatric ICU admission, nonorthopedic surgery, embolization or transfusion within 24 h. Under triage was defined by the number of injured patients with the need of specialized trauma care transported to a non-level I pediatric trauma center on the total number of injured patients that needed specialized trauma care.…”

“…However, the anatomic and physiologic characteristics of children makes prehospital triage a challenge [9]. A recent literature review documented the use of specific field triage protocols to children carried a high risk of under triage [10]. However, robust data on the effect of under triage on mortality after major trauma are still lacking.…”