THE NEED FOR PEDIATRIC-SPECIFIC TRIAGE CRITERIA - RESULTS FROM THE FLORIDA TRAUMA TRIAGE STUDY

Objective: The objective of the Florida Trauma Triage Study was to ass ess the performance of state-adopted held triage criteria. The study a ddressed three specific age groups: pediatric (age <15 years), adult ( age 15-51 years), and geriatric (age 55+ years). Since 1990, Florida h as used a uniform set of eight triage criteria, known as the trauma sc orecard, for triaging adult trauma patients to state-approved trauma c enters. However, only five of the criteria are recommended for use wit h pediatric patients, This article presents the findings regarding the performance of the scorecard when applied to a pediatric population. Design: We used state trauma registry data linked to state hospital di scharge data in a retrospective analysis of trauma patients transporte d by prehospital providers to any acute care hospital within nine sele cted Florida counties between July 1, 1991, and December 31, 1991, We used cross-table and logistic regression analysis to determine the abi lity of triage criteria to correctly identify patients who were retros pectively defined as major trauma. We applied the field criteria to ph ysiologic and anatomy/mechanism of injury data contained in the trauma registry to ''score'' the patient as major or minor trauma, To make o ur retrospective determination of major or minor trauma we used the pr otocols developed by an expert medical panel as described by E. J. Mac Kenzie et al. (1990). Main outcome measures: We calculated sensitivity , specificity, and the corresponding over- and undertriage rates by co mparing patient classifications (major or minor trauma) produced by th e triage criteria and the retrospective algorithm. We used logistic re gression to identify which triage criteria were statistically signific ant in predicting major trauma. Results: Pediatric cases accounted for 9.2% of the total study population, 6.0% of all hospitalized cases, a nd 6.8% of all trauma deaths. Of the 1505 pediatric cases available fo r analysis, the triage criteria classified 269 eases as expected major trauma and 1236 cases as expected minor trauma, The retrospective alg orithm classified 78 cases as expected major trauma and 1427 cases as expected minor trauma. The resulting specificity is 84.8% (15.2% overt riage), and the sensitivity is 66.7% (33.3% undertriage). Logistic reg ression indicated that, of the eight state-adopted field triage criter ia, only the Glasgow coma score, ejection from vehicle, and penetratin g injuries have a statistically significant impact on predicting major trauma in pediatric patients. Conclusions: Although the state-adopted trauma scorecard, applied to a pediatric population produced acceptab le overtriage, it did not produce acceptable undertriage, However, our undertriage rate is comparable to the results of other published stud ies on pediatric trauma, As a result of the Florida Trauma Triage Stud y, a new pediatric triage instrument was developed. It is currently be ing field-tested.