Prehospital triage in the injured pediatric patient

Background/Purpose: Identifying major trauma patients in the prehospital se tting is essential in determining management, destination, and best utiliza tion of emergency department resources. Few methods of trauma triage have b een accepted unanimously. This study prospectively evaluates the efficacy o f comprehensive field triage using 12 criteria (simplified version of the A merican College of Surgeon's guidelines) in 1,285 pediatric trauma patients . Methods: Major trauma was defined as occurring in those who died in the eme rgency room, had major surgery (penetrating injury involving surgery of the head, neck, chest, abdomen, or groin), or were admitted directly to the in tensive care unit. The correlation between trauma triage criteria, hospital disposition, and triage accuracy were determined prospectively and compare d in the pediatric patients (36 months) with an adult cohort of patients (1 2 months). Results: A total of 1,285 pediatric trauma patients were evaluated and comp ared with 1,326 adult trauma patients. The most accurate trauma triage crit erion for major injury was a blood pressure less than or equal to 90 mmHg ( systolic) with an accuracy of 86%. This was followed by burn greater than 1 5% total body surface area (79%), Glasgow Coma Scale score less than or equ al to 12 (78%), respiratory rate less than 10/min or greater than 29/min (7 3%), and paralysis (50%). Less accurate criteria included a fall from great er than 20 feet (33%); penetrating injury to head, neck, chest, abdomen, or groin (29%); ejection from vehicle (24%); pedestrian struck at greater tha n 20 mph (16%); paramedic judgement (12%); rollover (3%); and extrication ( 0%), The Glasgow Coma Scale score was a more accurate indicator of major in jury in children than adults, and paramedic judgement was less accurate in children when compared with adults. Of the 379 major pediatric trauma victi ms, the Revised Trauma Score and Pediatric Trauma Score missed 36% and 45% of these major trauma victims, respectively. The overtriage rate for childr en was 71% with a sensitivity of 100% (no missed major trauma patients). Conclusions: Physiological variables, anatomic site, and mechanism of injur y provide a sensitive and safe system of triage. Continued education of pre hospital personnel regarding pediatric trauma and stratification of the cur rent triage tools are necessary to minimize overtriage in an era of shrinki ng resources. Copyright (C) 2000 by W.B. Saunders Company.