A multicenter prospective analysis of pediatric trauma activation criteria routinely used in addition to the six criteria of the American College of Surgeons
| Autor: | Richard A. Falcone, David M. Gourlay, Barbara A. Gaines, Lisa Schwing, Anthony L DeRoss, Suzanne Moody, Eileen King, Johnathan I. Groner, Cinda Werner, David P. Meagher, J Crow, Ann Moss, Christine McKenna, Lynn Haas, Laura Cizmar, Nilda M. Garcia, Deb Brown, Rochelle Armola, Kathy Haley |
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| Rok vydání: | 2012 |
| Předmět: |
Male
medicine.medical_specialty Adolescent Critical Care and Intensive Care Medicine Risk Assessment Sensitivity and Specificity Cohort Studies Prospective analysis Injury Severity Score Trauma Centers Medicine Humans Hospital Mortality Prospective Studies Child Qualitative Research Societies Medical Patient Care Team Evidence-Based Medicine business.industry Diagnostic Tests Routine medicine.disease Triage Survival Analysis Child Preschool Emergency medicine Wounds and Injuries Surgery Female business Pediatric trauma |
| Zdroj: | The journal of trauma and acute care surgery. 73(2) |
| ISSN: | 2163-0763 |
| Popis: | The American College of Surgeons has defined six minimum activation criteria (ACS-6) for the highest level of trauma activations at trauma centers. The verification criteria also allow for the inclusion of additional criteria at the institution's discretion. The purpose of this prospective multicenter study was to evaluate the ACS-6 as well as commonly used activation criteria to evaluate overtriage and undertriage rates for pediatric trauma team activation.Data were prospectively collected at nine pediatric trauma centers to examine 29 commonly used activation criteria. Patients meeting any of these criteria were evaluated for the use of high-level trauma resuscitation resources according to an expert consensus list. Patients requiring a resource but not meeting any activation criteria were included to evaluate undertriage rates.During the 1-year study, a total of 656 patients were enrolled with a mean age of 8 years, a median Injury Severity Score of 14, and mortality of 11%. Using all criteria, 55% of patients would have been overtriaged and 9% would have been undertriaged. If only the ACS-6 were used, 24% of patients would have been overtriaged and 16% would have been undertriaged. Among activation criteria with more than 10 patients, those most predictive of using a high-level resource were a gunshot wound to the abdomen (92%), blood given before arrival (83%), traumatic arrest (83%), tachycardia/poor perfusion (83%), and age-appropriate hypotension (77%). The addition of tachycardia/poor perfusion and pretrauma center resuscitation with greater than 40 mL/kg results in eight criteria with an overtriage of 39% and an undertriage of 10.5%.The ACS-6 provides a reliable overtriage or undertriage rate for pediatric patients. The inclusion of two additional criteria can further improve these rates while maintianing a simplified triage list for children. |
| Databáze: | OpenAIRE |
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