W P Johnson1. 1. Metropolitan Dade County Office of Trauma Services, Miami, Florida. USA.
Abstract
INTRODUCTION: Triage of injured children poses a significant challenge for prehospital care providers because there is not single trauma triage tool in use that has been developed specifically for children. The pediatric trauma score (PTS) probably is the single most studied and tested trauma triage tool developed solely for the pediatric population, and is an effective predictor of both severity of injury and potential mortality in injured children. However, the pediatric trauma score has been found to be an ineffective prehospital triage tool because it is not "user friendly" for field personnel. As such, the PTS has been modified to generate the more user-friendly "pediatric trauma triage checklist (PTTC)." METHODS: This study retrospectively reviewed 106 prehospital run reports to determine whether the patient met one or more of the criteria in the PTTC. By applying the MacKenzie algorithm to outcome data for each case, it was possible to determine whether the patient should have been sent to a trauma center. RESULTS: The PTTC demonstrated a sensitivity of 86.2%, a specificity of 41.6%, and an accuracy of 66.0% The PTTC demonstrated an overtriage rate of 58.3% and an undertriage rate of 13.8% When compared with a previous study, the PTTC demonstrated a 74% increase in overtriage. However, the 59% reduction in undertriage is more important. CONCLUSIONS: Use of the PTTC appears to have merit as a pediatric prehospital trauma triage tool but further study is recommended. The PTTC should be tested in a prospective, multiregional study involving a sample size sufficient to reach statistical significance.
INTRODUCTION: Triage of injured children poses a significant challenge for prehospital care providers because there is not single trauma triage tool in use that has been developed specifically for children. The pediatric trauma score (PTS) probably is the single most studied and tested trauma triage tool developed solely for the pediatric population, and is an effective predictor of both severity of injury and potential mortality in injured children. However, the pediatric trauma score has been found to be an ineffective prehospital triage tool because it is not "user friendly" for field personnel. As such, the PTS has been modified to generate the more user-friendly "pediatric trauma triage checklist (PTTC)." METHODS: This study retrospectively reviewed 106 prehospital run reports to determine whether the patient met one or more of the criteria in the PTTC. By applying the MacKenzie algorithm to outcome data for each case, it was possible to determine whether the patient should have been sent to a trauma center. RESULTS: The PTTC demonstrated a sensitivity of 86.2%, a specificity of 41.6%, and an accuracy of 66.0% The PTTC demonstrated an overtriage rate of 58.3% and an undertriage rate of 13.8% When compared with a previous study, the PTTC demonstrated a 74% increase in overtriage. However, the 59% reduction in undertriage is more important. CONCLUSIONS: Use of the PTTC appears to have merit as a pediatric prehospital trauma triage tool but further study is recommended. The PTTC should be tested in a prospective, multiregional study involving a sample size sufficient to reach statistical significance.