Pediatric trauma triage: A Pediatric Trauma Society Research Committee systematic review

Abstract

BACKGROUND Significant variability exists in the triage of injured children with most systems using mechanism of injury and/or physiologic criteria. It is not well established if existing triage criteria predict the need for intervention or impact morbidity and mortality. This study evaluated existing evidence for pediatric trauma triage. Questions defined a priori were as follows: (1) Do prehospital trauma triage criteria reduce mortality? (2) Do prehospital trauma scoring systems predict outcomes? (3) Do trauma center activation criteria predict outcomes? (4) Do trauma center activation criteria predict need for procedural or operative interventions? (5) Do trauma bay pediatric trauma scoring systems predict outcomes? (6) What secondary triage criteria for transfer of children exist? METHODS A structured, systematic review was conducted, and multiple databases were queried using search terms related to pediatric trauma triage. The literature search was limited to January 1990 to August 2019. Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) methodology was applied with the methodological index for nonrandomized studies tool used to assess the quality of included studies. Qualitative analysis was performed. RESULTS A total of 1,752 articles were screened, and 38 were included in the qualitative analysis. Twelve articles addressed questions 1 and 2, 21 articles addressed question 3 to 5, and five articles addressed question 6. Existing literature suggest that prehospital triage criteria or scoring systems do not predict or reduce mortality, although selected physiologic parameters may. In contrast, hospital trauma activation criteria can predict the need for procedures or surgical intervention and identify patients with higher mortality; again, physiologic signs are more predictive than mechanism of injury. Currently, no standardized secondary triage/transfer protocols exist. CONCLUSION Evidence supporting the utility of prehospital triage criteria for injured children is insufficient, while physiology-based trauma system activation criteria do appropriately stratify injured children. The absence of strong evidence supports the need for further prehospital and secondary transfer triage-related research. LEVEL OF EVIDENCE Systematic review study, level II.

Pediatric Injury Transfer Patterns During the COVID-19 Pandemic: An Interrupted time Series Analysis

“…Pre-COVID studies have looked at the associations with likelihood of transfer from adult trauma centers to pediatric trauma centers and from lower level to higher level centers. ( 19 , 20 , 21 ) A 2020 Pediatric Trauma Society systematic review found that in general, young age, intracranial injury, and more severely injured patients are most consistently transferred. ( 21 ) Hamilton et al analyzed the National Trauma Databank from 2007-2012, and also identified female sex and lack of insurance as independent predictors of transfer.…”

“…( 19 , 20 , 21 ) A 2020 Pediatric Trauma Society systematic review found that in general, young age, intracranial injury, and more severely injured patients are most consistently transferred. ( 21 ) Hamilton et al analyzed the National Trauma Databank from 2007-2012, and also identified female sex and lack of insurance as independent predictors of transfer. Injuries sustained were not reported in this study.…”

Air Rescue for Pediatric Trauma in a Metropolitan Region of Brazil: Profiles, Outcomes, and Overtriage Rates

“…However, it has the disadvantage of being calculated based on diagnoses during hospitalization, thus not applicable for screening at the scene. Prehospital assessment of severity in pediatric trauma cases can be challenging due to the child's anatomy and physiology ( 21 , 25 , 26 ). The sensitivity of pediatric prehospital triage tools ranging has been reported to range from 49.1% to 87.3% ( 21 ), sometimes resulting in overtriage rates higher than 20% ( 22 ).…”

Consensus-driven model to establish paediatric emergency care measures for low-volume emergency departments

“…For example, early recognition of altered mental status is essential to timely management of head trauma. [23][24][25] Early recognition of tachycardia and hypotension are core components of sepsis recognition. 26 In turn, early recognition of the critically ill or injured child leads to timely administration of evidence-based interventions linked to improved outcomes.…”