Factors that predict the need for early surgeon presence in the setting of pediatric trauma

McGaha, Paul; Garwe, Tabitha; Stewart, Katharine E.; Sarwar, Zoona; Robbins, Justin M; Johnson, Jeremy J.; Letton, Robert W.

doi:10.1016/j.jpedsurg.2019.05.010

Cited by 7 publications

(4 citation statements)

References 18 publications

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“…While the heart rate ranges for reduced mortality risk in that study are similar to those reported in the present analysis, we identified cutoffs that may improve diagnostic accuracy. Several studies have reported significant findings of systolic hypotension using differing age-based criteria for the prediction of mortality and other clinically important outcomes, including traumatic brain injury and shock, among pediatric patients with trauma . Our approach corroborates other data-driven approaches to physiologic indicators of morbidity in pediatric trauma, such as the pediatric shock index …”

Section: Discussionsupporting

confidence: 79%

“…Several studies have reported significant findings of systolic hypotension using differing age-based criteria for the prediction of mortality and other clinically important outcomes, including traumatic brain injury and shock, among pediatric patients with trauma. 27 , 28 , 29 , 30 Our approach corroborates other data-driven approaches to physiologic indicators of morbidity in pediatric trauma, such as the pediatric shock index. 31 …”

Section: Discussionsupporting

confidence: 74%

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Comparison of Vital Sign Cutoffs to Identify Children With Major Trauma

Gorski,

Chaudhari,

Spurrier

et al. 2024

JAMA Netw Open

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ImportanceVital signs are essential components in the triage of injured children. The Advanced Trauma Life Support (ATLS) and Pediatric Advanced Life Support (PALS) physiologic criteria are frequently used for trauma assessments.ObjectiveTo evaluate the performance of ATLS and PALS criteria vs empirically derived criteria for identifying major trauma in children.Design, Setting, and ParticipantsThis retrospective cohort study used 2021 American College of Surgeons Trauma Quality Improvement Program (TQIP) data contributed by US trauma centers. Included encounters involved pediatric patients (aged &lt;18 years) with severe injury, excluding those who experienced out-of-hospital cardiac arrest, were receiving mechanical ventilation, or were transferred from another facility. Data were analyzed between April 9 and December 21, 2023.ExposureInitial hospital vital signs, including heart rate, respiratory rate, and systolic blood pressure (SBP).Main Outcome and MeasuresMajor trauma, determined by the Standard Triage Assessment Tool, a composite measure of injury severity and interventions performed. Multivariable models developed from PALS and ATLS vital sign criteria were compared with models developed from the empirically derived criteria using the area under the receiver operating characteristic curve. Validation of the findings was performed using the 2019 TQIP dataset.ResultsA total of 70 748 patients (median [IQR] age, 11 [5-15] years; 63.4% male) were included, of whom 3223 (4.6%) had major trauma. The PALS criteria classified 31.0% of heart rates, 25.7% of respiratory rates, and 57.4% of SBPs as abnormal. The ATLS criteria classified 25.3% of heart rates, 4.3% of respiratory rates, and 1.1% of SBPs as abnormal. Among children with all 3 vital signs documented (64 326 [90.9%]), PALS had a sensitivity of 88.4% (95% CI, 87.1%-89.3%) and specificity of 25.1% (95% CI, 24.7%-25.4%) for identifying major trauma, and ATLS had a sensitivity of 54.5% (95% CI, 52.7%-56.2%) and specificity of 72.9% (95% CI, 72.6%-73.3%). The empirically derived cutoff vital sign z scores had a sensitivity of 80.0% (95% CI, 78.5%-81.3%) and specificity of 48.7% (95% CI, 48.3%-49.1%) and area under the receiver operating characteristic curve of 70.9% (95% CI, 69.9%-71.8%), which was similar to PALS criteria (69.6%; 95% CI, 68.6%-70.6%) and greater than ATLS criteria (65.4%; 95% CI, 64.4%-66.3%). Validation using the 2019 TQIP database showed similar performance to the derivation sample.Conclusions and RelevanceThese findings suggest that empirically derived vital sign criteria strike a balance between the sensitivity of PALS criteria and the specificity of ATLS criteria in identifying major trauma in children. These criteria may help to identify children at greatest risk of trauma-related morbidity and mortality.

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Section: Discussionsupporting

confidence: 79%

Section: Discussionsupporting

confidence: 74%

Comparison of Vital Sign Cutoffs to Identify Children With Major Trauma

Gorski,

Chaudhari,

Spurrier

et al. 2024

JAMA Netw Open

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“…We previously showed hypotension, GCS12, and penetrating trauma reliably predicts NSP, which may allow for earlier identification of NSP. 4 Early identification of severe injury and prehospital interventions have been previously shown to improve outcomes. 9 This may be an advantage over other systems such as the Need for Trauma Intervention (NFTI) method, 10 in which many of the criteria are not readily known until 60e72 h after arrival.…”

Section: Discussionmentioning

confidence: 99%

“…Need for surgeon presence (NSP) as a marker for severe injury originated from previous work by Lerner et al In a retrospective study using a modified definition of the Lerner approach to NSP, we found that penetrating trauma is predictive of NSP upon patient arrival to the trauma bay. 4 This included all penetrating injuries. We found that patients in this population with a penetrating injury were 5.4 times more likely to require NSP than blunt trauma.…”

Section: Introductionmentioning

confidence: 99%

Is it time for firearm injury to be a separate activation criteria in children? An assessment of penetrating pediatric trauma using need for surgeon presence

McGaha

Stewart

Garwe

et al. 2021

The American Journal of Surgery

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Background: Penetrating injury independently predicts the need for surgeon presence (NSP) upon arrival. Penetrating injury is often used as a trauma triage indicator, however, it includes a wide range of specific mechanisms of injury. We sought to compare firearm-related and non-firearm related pediatric penetrating injuries with respect to NSP, ISS and mortality. Methods: Patients <18 from the 2016 National Trauma Quality Improvement Program Database were included. Penetrating injury was identified and grouped using ICD-10 mechanism codes into firearm and non-firearm related injury. NSP, ISS, and mortality were compared between the two groups. Results: A total of 1715 (4.2%) patients with penetrating injury were; 832 firearm-related and 883 nonfirearm. No deaths occurred among the non-firearm group compared to 94 (11.3%) among firearmrelated patients. Among non-firearm patients, 22.7% had a NSP indicator compared to 51.2% of patients injured by a firearm. Conclusion: There is a significantly higher proportion of severe injury and mortality with firearm penetrating injury when compared to non-firearm pediatric penetrating injury. Consideration should be given to dividing it into firearm and non-firearm penetrating injury.

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