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Ngo LC, Carroll HM, Massimilian SS, Garapaty N, Palladino K, Samuels SK, Lao OB, Parreco JP, Levene T. Optimizing Triage Practice in Pediatric Trauma: Lessons From Under-triage and Over-triage Rates and Risk Factors. Am Surg 2024; 90:1892-1895. [PMID: 38532308 DOI: 10.1177/00031348241241693] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/28/2024]
Abstract
BACKGROUND Triage accuracy is essential for delivering effective trauma care, especially in the pediatric population where unique challenges exist. The purpose of this study was to investigate risk factors contributing to under-triage and over-triage in an urban pediatric trauma center. METHODS This retrospective cohort study included all trauma activations at an urban level 1 trauma center between January 1, 2021, and July 31, 2023 (patients <18 years old.) Patients who were under- or over-triaged were identified based on the level of trauma activation and injury severity score. RESULTS There were 1094 trauma activations included in this study. The rate of under-triage was 3.8% (n = 42) and over-triage was 13.6% (n = 149). Infants aged 0-1 years had the highest rate of under-triage (10.9%, n = 19, P < .001), while those aged 11-17 had the highest rate of over-triage (17.0%, n = 82, P = .003). Non-accidental trauma was the strongest risk factor for under-triage (OR 30.2 [6.4-142.8] P < .001). Penetrating mechanism was the strongest risk factor for over-triage (OR 12.2 [5.6-26.2] P < .001). DISCUSSION This study reveals the complexity of trauma triage in the pediatric population. We identified key predictive factors, such as age, comorbidities, and mechanism of injury, that can be used to refine triage practices and improve the care of pediatric trauma patients.
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Affiliation(s)
- Lisa C Ngo
- Memorial Regional Hospital, Hollywood, FL, USA
| | | | | | - Nikitha Garapaty
- Nova Southeastern University Dr. Kiran C. Patel College of Allopathic Medicine, Fort Lauderdale, FL, USA
| | | | - Shenae K Samuels
- Memorial Healthcare System Office of Human Research, Hollywood, FL, USA
| | - Oliver B Lao
- Joe DiMaggio Children's Hospital, Hollywood, FL, USA
| | | | - Tamar Levene
- Joe DiMaggio Children's Hospital, Hollywood, FL, USA
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Gyedu A, Issaka A, Appiah AB, Donkor P, Mock C. Care of Injured Children Compared to Adults at District and Regional Hospitals in Ghana and the Impact of a Trauma Intake Form: A Stepped-Wedge Cluster Randomized Trial. J Pediatr Surg 2024; 59:1210-1218. [PMID: 38154994 PMCID: PMC11105994 DOI: 10.1016/j.jpedsurg.2023.12.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2023] [Revised: 11/16/2023] [Accepted: 12/03/2023] [Indexed: 12/30/2023]
Abstract
BACKGROUND This study aimed to determine the effectiveness of a standardized trauma intake form (TIF) to improve achievement of key performance indicators (KPIs) of initial trauma care among injured children, compared to adults, at non-tertiary hospitals in Ghana. METHODS A stepped-wedge cluster randomized trial was performed with research assistants directly observing the management of injured patients before and after introducing the TIF at emergency units of 8 non-tertiary hospitals for 17.5 months. Differences in outcomes between children and adults in periods before and after TIF introduction were determined with multivariable logistic regression. Differences in outcomes among children after TIF introduction were determined using generalized linear mixed regression. RESULTS Management of 3889 injured patients was observed; 757 (19%) were children <18 years. Trauma care KPIs at baseline were lower for children compared to adults. Improvements in primary survey KPIs were observed among children after TIF introduction. Examples include airway assessment [279 (71%) to 359 (98%); adjusted odds ratio (AOR): 74.42, p = 0.005)] and chest examination [225 (58%) to 349 (95%); AOR 53.80, p = 0.002)]. However, despite these improvements, achievement of KPIs was still lower compared to adults. Examples are pelvic fracture evaluation [children: 295 (80%) vs adults: 1416 (88%), AOR: 0.56, p = 0.001] and respiratory rate assessment (children: 310 (84%) vs adults: 1458 (91%), AOR: 058, p = 0.030). CONCLUSIONS While the TIF was effective in improving most KPIs of pediatric trauma care, more targeted education is needed to bridge the gap in quality between pediatric and adult trauma care at non-tertiary hospitals in Ghana and other low- and middle-income countries. TYPE OF STUDY Stepped-wedged cluster randomized controlled trial. LEVEL OF EVIDENCE I.
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Affiliation(s)
- Adam Gyedu
- Department of Surgery, School of Medicine and Dentistry, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana; University Hospital, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana.
| | - Adamu Issaka
- Department of Surgery, School of Medicine, University for Development Studies, Tamale, Ghana
| | - Anthony Baffour Appiah
- Ghana Field Epidemiology and Laboratory Training Program, School of Public Health, University of Ghana, Legon, Accra, Ghana
| | - Peter Donkor
- Department of Surgery, School of Medicine and Dentistry, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Charles Mock
- Department of Surgery, University of Washington, Seattle, WA, USA; Harborview Injury Prevention and Research Center, Seattle, WA, USA
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Reppucci ML, Cooper E, Nolan MM, Lyttle BD, Gallagher LT, Jujare S, Stevens J, Moulton SL, Bensard DD, Acker SN. Use of prehospital reverse shock index times Glasgow Coma Scale to identify children who require the most immediate trauma care. J Trauma Acute Care Surg 2023; 95:347-353. [PMID: 36899455 DOI: 10.1097/ta.0000000000003903] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/12/2023]
Abstract
BACKGROUND Appropriate prehospital trauma triage ensures transport of children to facilities that provide specialized trauma care. There are currently no objective and generalizable scoring tool for emergency medical services to facilitate such decisions. An abnormal reverse shock index times Glasgow Coma Scale (rSIG), which is calculated using readily available parameters, has been shown to be associated with severely injured children. This study sought to determine if rSIG could be used in the prehospital setting to identify injured children who require the highest levels of care. METHODS Patients (1-18 years old) transferred from the scene to a level 1 pediatric trauma center from 2010 to 2020 with complete prehospital and emergency department vital signs, and Glasgow Coma Scale (GCS) scores were included. Reverse shock index times GCS was calculated as previously described ((systolic blood pressure/heart rate) × GCS), and the following cutoffs were used: ≤13.1, ≤16.5, and ≤20.1 for 1- to 6-, 7- to 12-, and 13- to 18-year-old patients, respectively. Trauma activation level and clinical outcomes upon arrival to the pediatric trauma center were collected. RESULTS There were 247 patients included in the analysis; 66.0% (163) had an abnormal prehospital rSIG. Patients with an abnormal rSIG had a higher rate of highest-level trauma activation compared with those with a normal rSIG (38.7% vs. 20.2%, p = 0.013). Patients with an abnormal prehospital rSIG also had higher rates of intubation (28.8% vs. 9.52%, p < 0.001), intracranial pressure monitor (9.20 vs. 1.19%, p = 0.032), need for blood (19.6% vs. 8.33%, p = 0.034), laparotomy (7.98% vs. 1.19%, p = 0.039), and intensive care unit admission (54.6% vs. 40.5%, p = 0.049). CONCLUSION Reverse shock index times GCS may assist emergency medical service providers in early identification and triage of severely injured children. An abnormal rSIG in the emergency department is associated with higher rates of intubation, need for blood transfusion, intracranial pressure monitoring, laparotomy, and intensive care unit admission. Use of this metric may help to speed the identification, care, and treatment of any injured child. LEVEL OF EVIDENCE Prognostic and Epidemiological; Level IV.
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Affiliation(s)
- Marina L Reppucci
- From the Department of Surgery (M.L.R.), The Mount Sinai Hospital, New York, New York; Children's Hospital Center for Research in Outcomes for Children's Surgery (E.C.), Children's Hospital Colorado, Aurora, Colorado; Pediatric Surgery (M.M.N., B.D.L., L.T.G., S.J., S.L.M., D.D.B., S.N.A.), Children's Hospital Colorado; Division of Pediatric Surgery, Department of Surgery (B.D.L., L.T.G., S.L.M., D.D.B., S.N.A.), University of Colorado School of Medicine, Aurora, Colorado; Department of Surgery (J.S.), Louisiana State University Health Sciences Center, New Orleans, Louisiana; and Pediatric Surgery, Denver Health (D.D.B.), Denver, Colorado
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Sullivan TM, Milestone ZP, Colson CD, Tempel PE, Gestrich-Thompson WV, Burd RS. Evaluation of Missing Prehospital Physiological Values in Injured Children and Adolescents. J Surg Res 2023; 283:305-312. [PMID: 36423480 PMCID: PMC9990680 DOI: 10.1016/j.jss.2022.10.033] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2022] [Revised: 08/11/2022] [Accepted: 10/16/2022] [Indexed: 11/23/2022]
Abstract
INTRODUCTION Prehospital vital signs and the Glasgow Coma Scale score are often missing in clinical practice and not recorded in trauma databases. Our study aimed to identify factors associated with missing prehospital physiological values, including systolic blood pressure, heart rate, respiratory rate, peripheral oxygen saturation, and Glasgow Coma Scale. METHODS We used our hospital trauma registry to obtain patient, injury, resuscitation, and transportation characteristics for injured children and adolescents (age <15 y). We evaluated the association of missing documentation of prehospital values with other patient, injury, transportation, and resuscitation characteristics using multivariable regression. We standardized vital sign values using age-adjusted z-scores. RESULTS The odds of a missing physiological value decreased with age (odds ratio [OR] = 0.9, 95% confidence interval [CI] = 0.9, 0.9) and were higher when prehospital cardiopulmonary resuscitation was required (OR = 3.3, 95% CI = 1.9, 5.7). Among the physiological values considered, we observed the highest odds of missingness of systolic blood pressure, respiratory rate, and oxygen saturation. The odds of observing normal emergency department physiological values were lower when prehospital physiological values were missing (OR = 0.9, 95% CI = 0.9, 1.0; P = 0.04). CONCLUSIONS Missing prehospital physiological values were associated with younger age and cardiopulmonary resuscitation among the injured children treated at our hospital. Measurement and documentation of physiological variables of patients with these characteristics should be targeted.
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Affiliation(s)
- Travis M Sullivan
- Division of Trauma and Burn Surgery, Children's National Hospital, Washington, District of Columbia
| | - Zachary P Milestone
- Division of Trauma and Burn Surgery, Children's National Hospital, Washington, District of Columbia
| | - Cindy D Colson
- Division of Trauma and Burn Surgery, Children's National Hospital, Washington, District of Columbia
| | - Peyton E Tempel
- Division of Trauma and Burn Surgery, Children's National Hospital, Washington, District of Columbia
| | | | - Randall S Burd
- Division of Trauma and Burn Surgery, Children's National Hospital, Washington, District of Columbia.
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Sullivan TM, Gestrich-Thompson WV, Milestone ZP, Burd RS. Time is tissue: Barriers to timely transfusion after pediatric injury. J Trauma Acute Care Surg 2023; 94:S22-S28. [PMID: 35916621 PMCID: PMC9805480 DOI: 10.1097/ta.0000000000003752] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
ABSTRACT Strategies to improve outcomes among children and adolescents in hemorrhagic shock have primarily focused on component resuscitation, pharmaceutical coagulation adjuncts, and hemorrhage control techniques. Many of these strategies have been associated with better outcomes in children, but the barriers to their use and the impact of timely use on morbidity and mortality have received little attention. Because transfusion is uncommon in injured children, few studies have identified and described barriers to the processes of using these interventions in bleeding patients, processes that move from the decision to transfuse, to obtaining the necessary blood products and adjuncts, and to delivering them to the patient. In this review, we identify and describe the steps needed to ensure timely blood transfusion and propose practices to minimize barriers in this process. Given the potential impact of time on hemorrhage associated outcomes, ensuring timely intervention may have a similar or greater impact than the interventions themselves.
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Affiliation(s)
- Travis M. Sullivan
- Division of Trauma and Burn Surgery, Children’s National Hospital, Washington, DC
| | | | - Zachary P. Milestone
- Division of Trauma and Burn Surgery, Children’s National Hospital, Washington, DC
| | - Randall S. Burd
- Division of Trauma and Burn Surgery, Children’s National Hospital, Washington, DC
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Patient Outcomes Based on the 2011 CDC Guidelines for Field Triage of Injured Patients. J Trauma Nurs 2023; 30:5-13. [PMID: 36633338 DOI: 10.1097/jtn.0000000000000691] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
BACKGROUND The Centers for Disease Control and Prevention Guidelines for Field Triage of Injured Patients drive the destination decision for millions of emergency medical services (EMS)-transported trauma patients annually, yet limited information exists regarding performance and relationship with patient outcomes as a whole. OBJECTIVE To evaluate the association of positive findings on Centers for Disease Control and Prevention Guidelines for Field Triage of Injured Patients with hospitalization and mortality. METHODS This retrospective study included all 911 responses from the 2019 ESO Data Collaborative research dataset with complete Centers for Disease Control and Prevention Guidelines for Field Triage of Injured Patients and linked emergency department dispositions, excluding children and cardiac arrests prior to EMS arrival. Patients were categorized by Centers for Disease Control and Prevention Guidelines for Field Triage of Injured Patients step(s) met. Outcomes were hospitalization and emergency department or inhospital mortality. RESULTS There were 86,462 records included: n = 65,967 (76.3%) met no criteria, n = 16,443 (19.0%) met one step (n = 1,571 [9.6%] vitals, n = 1,030 [6.3%] anatomy of injury, n = 993 [6.0%] mechanism of injury, and n = 12,849 [78.1%] special considerations), and n = 4,052 (4.7%) met multiple. Compared with meeting no criteria, hospitalization odds increased threefold for vitals (odds ratio [OR]: 3.07, 95% confidence interval [CI]: 2.77-3.40), fourfold for anatomy of injury (OR: 3.94, 95% CI: 3.48-4.46), twofold for mechanism of injury (OR: 2.00, 95% CI: 1.74-2.29), or special considerations (OR: 2.46, 95% CI: 2.36-2.56). Hospitalization odds increased ninefold when positive in multiple steps (OR: 8.97, 95% CI: 8.37-9.62). Overall, n = 84,473 (97.7%) had mortality data available, and n = 886 (1.0%) died. When compared with meeting no criteria, mortality odds increased 10-fold when positive in vitals (OR: 9.58, 95% CI: 7.30-12.56), twofold for anatomy of injury (OR: 2.34, 95% CI: 1.28-4.29), or special considerations (OR: 2.10, 95% CI: 1.71-2.60). There was no difference when only positive for mechanism of injury (OR: 0.22, 95% CI: 0.03-1.54). Mortality odds increased 23-fold when positive in multiple steps (OR: 22.7, 95% CI: 19.7-26.8). CONCLUSIONS Patients meeting multiple Centers for Disease Control and Prevention Guidelines for Field Triage of Injured Patients steps were at greater risk of hospitalization and death. When meeting only one step, anatomy of injury was associated with greater risk of hospitalization; vital sign criteria were associated with greater risk of mortality.
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Shinohara M, Muguruma T, Toida C, Gakumazawa M, Abe T, Takeuchi I. The association between age and vital signs documentation of trauma patients in prehospital settings: analysis of a nationwide database in Japan. BMC Emerg Med 2022; 22:165. [PMID: 36195850 PMCID: PMC9531500 DOI: 10.1186/s12873-022-00725-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2022] [Accepted: 09/26/2022] [Indexed: 11/27/2022] Open
Abstract
Background Emergency medical service (EMS) providers are the first medical professionals to make contact with patients in an emergency. However, the frequency of care by EMS providers for severely injured children is limited. Vital signs are important factors in assessing critically ill or injured patients in the prehospital setting. However, it has been reported that documentation of pediatric vital signs is sometimes omitted, and little is known regarding the performance rate of vital sign documentation by EMS providers in Japan. Using a nationwide data base in Japan, this study aimed to evaluate the relationship between patients’ age and the documentation of vital signs in prehospital settings. Methods This study was a secondary data analysis of the Japan Trauma Data Bank. The inclusion criterion was patients with severe trauma, as defined by an Injury Severity Score ≥ 16. Our primary outcome was the rate of recording all four basic vital signs, namely blood pressure, heart rate, respiratory rate, and level of consciousness in the prehospital setting among different age groups. We also compared the prehospital vital sign completion rate, that is, the rate at which all four vital signs were recorded in a prehospital setting based on age groups. Multivariate analysis was performed to evaluate factors associated with the prehospital vital sign completion rate. Results We analyzed 75,777 severely injured patients. Adults accounted for 94% (71400) of these severely injured patients, whereas only 6% of patients were children. The rate of prehospital recording of vital signs was lower in children ≤5 years than in adult patients for all four vital signs. When the adult group was used as a reference, the adjusted odds ratios of vital sign completion rate in infants (0 years), younger children (1–5 years), older children (6–11 years), and teenagers (12–17 years) were 0.09, 0.30, 0.78, and 0.87, respectively. Conclusions Analysis of the nationwide trauma registry showed that younger children tended to have a lower rate of vital sign documentation in prehospital settings.
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Affiliation(s)
- Mafumi Shinohara
- Advanced Critical Care and Emergency Center,
- Yokohama City University Medical Center, 4-57 Urafunecho. Minamiku, Yokohama City, Kanagawa, 232-0024, Japan.
| | - Takashi Muguruma
- Advanced Critical Care and Emergency Center,
- Yokohama City University Medical Center, 4-57 Urafunecho. Minamiku, Yokohama City, Kanagawa, 232-0024, Japan
| | - Chiaki Toida
- Advanced Critical Care and Emergency Center,
- Yokohama City University Medical Center, 4-57 Urafunecho. Minamiku, Yokohama City, Kanagawa, 232-0024, Japan
| | - Masayasu Gakumazawa
- Advanced Critical Care and Emergency Center,
- Yokohama City University Medical Center, 4-57 Urafunecho. Minamiku, Yokohama City, Kanagawa, 232-0024, Japan
| | - Takeru Abe
- Advanced Critical Care and Emergency Center,
- Yokohama City University Medical Center, 4-57 Urafunecho. Minamiku, Yokohama City, Kanagawa, 232-0024, Japan
| | - Ichiro Takeuchi
- Advanced Critical Care and Emergency Center,
- Yokohama City University Medical Center, 4-57 Urafunecho. Minamiku, Yokohama City, Kanagawa, 232-0024, Japan
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Snyder CW, Barry TM, Ciesla DJ, Thatch K, Poulos N, Danielson PD, Chandler NM, Pracht EE. The International Classification of Disease Critical Care Severity Score demonstrates that pediatric burden of injury is similar to that of adults: Validation using the National Trauma Databank ☆. J Pediatr Surg 2022; 57:1354-1357. [PMID: 34172286 DOI: 10.1016/j.jpedsurg.2021.05.013] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2021] [Revised: 05/13/2021] [Accepted: 05/20/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND/PURPOSE Resource-based severity of injury (SOI) measures, such as the International Classification of Disease (ICD) Critical Care Severity Score (ICASS), may characterize traumatic burden better than standard mortality-based measures. The purpose of this study was to validate the ICASS in a representative national-level trauma cohort and compare SOI measures between children and adults. METHODS The National Trauma Databank was used to derive (2008-12) and validate (2013-15) ICASS and ICD Injury Severity Scores (ICISS, standard mortality-based SOI measure). SOI metrics and outcomes were compared between pediatric, adult, and elderly age groups. Logistic regression modeling evaluated predictors of critical care resource utilization. RESULTS Derivation and validation cohorts consisted of 3.90 and 1.97 million patients, respectively. ICASS strongly predicted actual critical care utilization (OR 1.04, 95% CI 1.04-1.04, p<0.0001). Mean ICASS was 24.4 for children and 33.0 for adults (ratio 0.74), indicating predicted critical care utilization in children was three-quarters that of adults. In contrast, predicted pediatric mortality was less than half that of adults. CONCLUSIONS Mortality-based SOI measures underestimate pediatric burden of injury. This study validates ICASS and demonstrates that pediatric resource-based SOI is more similar to that of adults. ICASS is easily calculated without a trauma registry and complements mortality-based measures. Level of evidence III, retrospective comparative study.
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Affiliation(s)
- Christopher W Snyder
- Division of Pediatric Surgery, Johns Hopkins All Children's Hospital, 601 5th Street South, St. Petersburg, FL, United States.
| | - Tara M Barry
- Division of Trauma and Acute Care Surgery, University of South Florida, 1 Tampa General Circle, Tampa, Florida, United States
| | - David J Ciesla
- Division of Trauma and Acute Care Surgery, University of South Florida, 1 Tampa General Circle, Tampa, Florida, United States
| | - Keith Thatch
- Division of Pediatric Surgery, Johns Hopkins All Children's Hospital, 601 5th Street South, St. Petersburg, FL, United States
| | - Nicholas Poulos
- Division of Pediatric Surgery, Wolfson Children's Hospital, 800 Prudential Drive, Jacksonville, FL, United States
| | - Paul D Danielson
- Division of Pediatric Surgery, Johns Hopkins All Children's Hospital, 601 5th Street South, St. Petersburg, FL, United States
| | - Nicole M Chandler
- Division of Pediatric Surgery, Johns Hopkins All Children's Hospital, 601 5th Street South, St. Petersburg, FL, United States
| | - Etienne E Pracht
- College of Public Health, University of South Florida, 13201 Bruce B. Downs Boulevard, Tampa, FL, United States
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Mosca CG, Stein C, Lawrence H. South African pre-hospital emergency care personnel's lived experiences of managing paediatric emergencies: A qualitative research design utilising one-on-one interviews. Health SA 2021; 26:1558. [PMID: 34394964 PMCID: PMC8335770 DOI: 10.4102/hsag.v26i0.1558] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2020] [Accepted: 04/21/2021] [Indexed: 11/28/2022] Open
Abstract
Background The phenomenon of managing paediatric emergencies in the pre-hospital environment within the South African setting is poorly understood with specific regard to what emergency care personnel are experiencing when managing paediatric emergencies. Aim The aim of this study was to explore and describe the lived experiences of emergency care personnel in managing paediatric patients in the pre-hospital environment and to understand the meaning and the significance of these experiences. Setting All participants were purposively sampled from emergency medical services agencies operating within the Johannesburg metropolitan city area. Methods This study followed a qualitative, exploratory, descriptive, phenomenological design, whereby participants purposively sampled within the Johannesburg metropolitan city voluntarily consented to one-on-one interviews (n = 10). Results Three main themes, with 11 contributing categories, were identified and contextualised with available literature. Emerging from the main themes was an overall sense that managing paediatric emergencies is a negative experience, coloured with feelings of inadequacy, stress, anxiety and even fear. Conclusions The findings of this study provided new insights into what South African EMS are experiencing when managing paediatric emergencies, which enables future research efforts to identify research and practice gaps that are relevant to paediatric pre-hospital emergency care, and that are specific to the South African environment. Contribution This research provides preliminary insight into the lived experiences of prehospital personnel managing paediatric emergencies as well as emerging recommendations for the improvement of the prehospital care of paediatric patients.
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Affiliation(s)
- Colin G Mosca
- Department of Emergency Medical Care, Faculty of Health Science, University of Johannesburg, Johannesburg, South Africa
| | - Christopher Stein
- Department of Emergency Medical Care, Faculty of Health Science, University of Johannesburg, Johannesburg, South Africa
| | - Heather Lawrence
- Department of Allied Health Professions, Faculty of Health and Applied Sciences, University of the West of England, Bristol, United Kingdom
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Ageron FX, Porteaud J, Evain JN, Millet A, Greze J, Vallot C, Levrat A, Mortamet G, Bouzat P. Effect of under triage on early mortality after major pediatric trauma: a registry-based propensity score matching analysis. World J Emerg Surg 2021; 16:1. [PMID: 33413465 PMCID: PMC7791780 DOI: 10.1186/s13017-020-00345-w] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2020] [Accepted: 12/10/2020] [Indexed: 11/29/2022] Open
Abstract
Background Little is known about the effect of under triage on early mortality in trauma in a pediatric population. Our objective is to describe the effect of under triage on 24-h mortality after major pediatric trauma in a regional trauma system. Methods This cohort study was conducted from January 2009 to December 2017. Data were obtained from the registry of the Northern French Alps Trauma System. The network guidelines triage pediatric trauma patients according to an algorithm shared with adult patients. Under triage was defined by the number of pediatric trauma patients that required specialized trauma care transported to a non-level I pediatric trauma center on the total number of injured patients with critical resource use. The effect of under triage on 24-h mortality was assessed with inverse probability treatment weighting (IPTW) and a propensity score (Ps) matching analysis. Results A total of 1143 pediatric patients were included (mean [SD], age 10 [5] years), mainly after a blunt trauma (1130 [99%]). Of the children, 402 (35%) had an ISS higher than 15 and 547 (48%) required specialized trauma care. Nineteen (1.7%) patients died within 24 h. Under triage rate was 33% based on the need of specialized trauma care. Under triage of children requiring specialized trauma care increased the risk of death in IPTW (risk difference 6.0 [95% CI 1.3–10.7]) and Ps matching analyses (risk difference 3.1 [95% CI 0.8–5.4]). Conclusions In a regional inclusive trauma system, under triage increased the risk of early death after pediatric major trauma.
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Affiliation(s)
- François-Xavier Ageron
- RENAU Northern French Alps Emergency Network, Public Health Department, Annecy Hospital, F-74000, Annecy, France
| | - Jordan Porteaud
- Grenoble Alps Trauma Center, Department of Anesthesiology and Intensive Care Medicine, Grenoble University Hospital, F-38000, Grenoble, France
| | - Jean-Noël Evain
- Grenoble Alps Trauma Center, Department of Anesthesiology and Intensive Care Medicine, Grenoble University Hospital, F-38000, Grenoble, France
| | - Anne Millet
- Department of Pediatric Care, Pediatric Intensive Care Unit, Grenoble University Hospital, F-38000, Grenoble, France
| | - Jules Greze
- Grenoble Alps Trauma Center, Department of Anesthesiology and Intensive Care Medicine, Grenoble University Hospital, F-38000, Grenoble, France
| | - Cécile Vallot
- RENAU Northern French Alps Emergency Network, Public Health Department, Annecy Hospital, F-74000, Annecy, France
| | - Albrice Levrat
- Department of Intensive Care, Annecy Hospital, F-74000, Annecy, France
| | - Guillaume Mortamet
- Department of Pediatric Care, Pediatric Intensive Care Unit, Grenoble University Hospital, F-38000, Grenoble, France.,Grenoble Alps University, F-38000, Grenoble, France
| | - Pierre Bouzat
- Grenoble Alps Trauma Center, Department of Anesthesiology and Intensive Care Medicine, Grenoble University Hospital, F-38000, Grenoble, France. .,Grenoble Alps University, F-38000, Grenoble, France. .,Grenoble Alpes Trauma Centre, Pôle d'Anesthésie-Réanimation, Hôpital Albert Michallon, BP 217, F-38043, Grenoble, France.
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11
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Asmar S, Zeeshan M, Khurrum M, Con J, Chehab M, Bible L, Latifi R, Joseph B. Delta Shock Index Predicts Outcomes in Pediatric Trauma Patients Regardless of Age. J Surg Res 2020; 259:182-191. [PMID: 33290893 DOI: 10.1016/j.jss.2020.10.026] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2020] [Revised: 10/01/2020] [Accepted: 10/31/2020] [Indexed: 11/18/2022]
Abstract
INTRODUCTION Changes in the shock index (ΔSI) can be a predictive tool but is not established among pediatric trauma patients. The aim of our study was to assess the impact of ΔSI on mortality in pediatric trauma patients. METHODS We performed a 2017 analysis of all pediatric trauma patients (age 0-16 y) from the ACS-TQIP. SI was defined as heart rate(HR)/systolic blood pressure(SBP). We abstracted the SI in the field (EMS), SI in the emergency department (ED) and calculated the change in SI (ΔSI = ED SI-EMS SI). Patients were divided into four age groups: 0-3 y, 4-6 y, 7-12 y, and 13-16 y and substratified into two groups based on the value of the age-group-specific ΔSI cutoff obtained with receiver operating characteristic ROC analysis; +ΔSI and -ΔSI. Our outcome measure was mortality. Multivariable logistic and Cox regression analyses were performed. RESULTS We included 31,490 patients. Mean age was 10.6 ± 4.6 y, and 65.8% were male. The overall mortality rate was 1.4%. In the age group 0-3 y the cutoff point for ΔSI was 0.29 with an area under the curve (AUC) 0.70 [0.62-0.79], ΔSI cutoff 4-6 y was 0.41 AUC 0.81 [0.70-0.92], ΔSI cutoff 7-12 y was 0.05 AUC 0.83 [0.76-0.90], and ΔSI cutoff 13-16 y was 0.13 AUC 0.75 [0.69-0.81]. On the Cox regression analysis, +ΔSI was independently associated with increased in-hospital mortality and 24-h mortality (P ≤ 0.01). CONCLUSIONS Vital signs vary by age group in children, but ΔSI inherently accounts for this variation. ΔSI predicts mortality and may be utilized as a predictor to help guide triage of pediatric trauma patients. LEVEL OF EVIDENCE Level III Prognostic.
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Affiliation(s)
- Samer Asmar
- Division of Trauma, Critical Care, Department of Surgery, Emergency Surgery, and Burns, College of Medicine, University of Arizona, Tucson, Arizona
| | - Muhammad Zeeshan
- Department of Surgery, Westchester Medical Center, Valhalla, New York
| | - Muhammad Khurrum
- Division of Trauma, Critical Care, Department of Surgery, Emergency Surgery, and Burns, College of Medicine, University of Arizona, Tucson, Arizona
| | - Jorge Con
- Department of Surgery, Westchester Medical Center, Valhalla, New York
| | - Mohamad Chehab
- Division of Trauma, Critical Care, Department of Surgery, Emergency Surgery, and Burns, College of Medicine, University of Arizona, Tucson, Arizona
| | - Letitia Bible
- Division of Trauma, Critical Care, Department of Surgery, Emergency Surgery, and Burns, College of Medicine, University of Arizona, Tucson, Arizona
| | - Rifat Latifi
- Department of Surgery, Westchester Medical Center, Valhalla, New York
| | - Bellal Joseph
- Division of Trauma, Critical Care, Department of Surgery, Emergency Surgery, and Burns, College of Medicine, University of Arizona, Tucson, Arizona.
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Hartka T, Vaca FE. Factors associated with EMS transport decisions for pediatric patients after motor vehicle collisions. TRAFFIC INJURY PREVENTION 2020; 21:S60-S65. [PMID: 33119415 PMCID: PMC8081732 DOI: 10.1080/15389588.2020.1830382] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/06/2020] [Revised: 08/31/2020] [Accepted: 09/27/2020] [Indexed: 06/11/2023]
Abstract
OBJECTIVE Prehospital non-transport events occur when emergency medicine service (EMS) providers respond to a scene, but the patient is ultimately not transported to a hospital for evaluation. The objective of this study was to determine the rate of non-transport of pediatric patients who were involved in a motor vehicle collision (MVC) and the factors associated with non-transport decisions. METHODS We searched the National Emergency Medical Services Information System (NEMSIS) database using ICD-10 mechanism of injury codes to identify cases in which EMS responded to a pediatric occupant (age < 18 years) who had been involved in an MVC. We excluded interfacility transports, scene assists, deaths at the scene, and collisions that occurred outside the US. The outcome of interest was if pediatric patients were not transported to a hospital for evaluation. We performed univariate and multivariate analysis to identify which risk factors were associated with non-transport. We also analyzed regional variation and the reasons recorded for not transporting patients. RESULTS We identified 92,254 pediatric patients who were evaluated by EMS after an MVC, of which 31,404 (34.0%) were not transported to a hospital for evaluation. In our adjusted analysis, the factors associated with non-transport were age <1 year or >16 years, male sex, normal Glasgow Coma Scale (GCS = 15), level of training of EMS providers, response time later than 6 a.m., and region of the country. GCS was the most important factor, with only 3.0% (108/3,616) of patients not transported who had abnormal GCS (< 15). In cases of non-transport, 32.7% (10257) were due to patient or caregiver refusal, and 33.3% (10,442) were due to patients being discharged against medical advice. Only 11.5% (3,627) pediatric patients who were not transported were discharged based on an established protocol. CONCLUSIONS Pediatric patients were not transported after EMS responded to an MVC in approximately one-third of cases, and there was considerable variation in the rate of non-transports based on geographic region, provider level, and time of day. The majority of non-transports occurred because patients were discharged against medical advice or the patient/caregiver refused transport, which may indicate conflicting priorities between EMS providers and patients.
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Affiliation(s)
- Thomas Hartka
- Department of Emergency Medicine, University of Virginia, Charlottesville, Virginia
| | - Federico E. Vaca
- Department of Emergency Medicine and the Yale Developmental Neurocognitive Driving Simulation Research Center, Yale School of Medicine, New Haven, Connecticut
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So you need a surgeon? Need for surgeon presence as an alternative metric to predict outcomes and assess triage in the pediatric trauma population. J Pediatr Surg 2020; 55:2124-2127. [PMID: 31761456 PMCID: PMC9587694 DOI: 10.1016/j.jpedsurg.2019.10.055] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/20/2019] [Revised: 10/04/2019] [Accepted: 10/10/2019] [Indexed: 11/21/2022]
Abstract
BACKGROUND Injury Severity Score (ISS) is the primary metric by which triage has been evaluated in trauma activations. We compared ISS to a previously described set of criteria defined as Need for Surgical Presence (NSP). We hypothesize that NSP may serve as a way to augment ISS in predicting mortality and assessing triage in pediatric trauma patients. METHODS A total of 19,139 pediatric trauma patients in the 2016 National Trauma Quality Improvement Program Database (excluding transfers) had complete data for mortality, mode of transport, age, injury type, ISS, and NSP factors. NSP was defined as having one or more of the following: intubation, transfusion, operation for hemorrhage control/craniotomy, vasopressors, interventional radiology, spinal cord Injury, tube thoracostomy, emergency thoracotomy, intracranial pressure monitor, or pericardiocentesis. RESULTS Overall mortality was 1.3% and 96% of all patients suffered blunt injury. A total of 2787 (14.6%) patients had an NSP indicator compared to 2036 (10.8%) with an ISS ≥16. NSP was noninferior to ISS in predicting mortality with the AUC of 0.91 (95% CI 0.89-0.92) and 0.90 (95% CI 0.88-0.92) respectively. CONCLUSION NSP predicts mortality in pediatric trauma patients as well as ISS, and may compliment ISS. NSP status can be assigned shortly after patient arrival. Proper assessment of over and undertriage allows for optimal resource utilization by the medical facility and ultimately benefits the hospital, physician and patient. STUDY TYPE Retrospective national dataset study. LEVEL OF EVIDENCE Level II.
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Two novel resource-based metrics to quantify pediatric trauma severity based on probability of requiring critical care and anesthesia services. J Trauma Acute Care Surg 2020; 89:636-641. [DOI: 10.1097/ta.0000000000002607] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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16
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van der Sluijs R, Lokerman RD, Waalwijk JF, de Jongh MAC, Edwards MJR, den Hartog D, Giannakópoulos GF, van Grunsven PM, Poeze M, Leenen LPH, van Heijl M. Accuracy of pre-hospital trauma triage and field triage decision rules in children (P2-T2 study): an observational study. THE LANCET CHILD & ADOLESCENT HEALTH 2020; 4:290-298. [PMID: 32014121 DOI: 10.1016/s2352-4642(19)30431-6] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/27/2019] [Revised: 12/16/2019] [Accepted: 12/19/2019] [Indexed: 11/26/2022]
Abstract
BACKGROUND Adequate pre-hospital trauma triage is crucial to enable optimal care in inclusive trauma systems. Transport of children in need of specialised trauma care to lower-level trauma centres is associated with adverse patient outcomes. We aimed to evaluate the diagnostic accuracy of paediatric field triage based on patient destination and triage tools. METHODS We did a multisite observational study (P2-T2) of all children (aged <16 years) transported with high priority by ambulance from the scene of injury to any emergency department in seven of 11 inclusive trauma regions in the Netherlands. Diagnostic accuracy based on the initial transport destination was evaluated in terms of undertriage rate (ie, the proportion of patients in need of specialised trauma care who were initially transported to a lower-level paediatric or adult trauma centre) and overtriage rate (ie, the proportion of patients not requiring specialised trauma care who were transported to a level-I [highest level] paediatric trauma centre). The Dutch National Protocol of Ambulance Services and Field Triage Decision Scheme triage protocols were externally validated using data from this cohort against an anatomical (Injury Severity Score [ISS] ≥16) and a resource-based reference standard. FINDINGS Between Jan 1, 2015, and Dec 31, 2017, 12 915 children (median age 10·3 years, IQR 4·2-13·6) were transported to the emergency department with injuries. 4091 (31·7%) patients were admitted to hospital, of whom 129 (3·2%) patients had an ISS of 16 or greater and 227 (5·5%) patients used critical resources within a limited timeframe. Ten patients died within 24 h of arrival at the emergency department. Based on the primary reference standard (ISS ≥16), the undertriage rate was 16·3% (95% CI 10·8-23·7) and the overtriage rate was 21·2% (20·5-22·0). The National Protocol of Ambulance Services had a sensitivity of 53·5% (95% CI 43·9-62·9) and a specificity of 94·0% (93·4-94·6), and the Field Triage Decision Scheme had a sensitivity of 64·5% (54·1-74·1) and a specificity of 84·3% (83·1-85·5). INTERPRETATION Too many children in need of specialised care were transported to lower-level paediatric or adult trauma centres, which is associated with increased mortality and morbidity. Current protocols cannot accurately discriminate between patients at low and high risk, and highly sensitive and child-specific triage tools need to be developed to ensure the right patient is transported to the right hospital. FUNDING The Netherlands Organisation for Health Research and Development, Innovation Fund Health Insurers.
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Affiliation(s)
- Rogier van der Sluijs
- Department of Surgery, University Medical Centre Utrecht, Utrecht, Netherlands; Department of Surgery, Maastricht University Medical Centre, Maastricht, Netherlands.
| | - Robin D Lokerman
- Department of Surgery, University Medical Centre Utrecht, Utrecht, Netherlands
| | - Job F Waalwijk
- Department of Surgery, University Medical Centre Utrecht, Utrecht, Netherlands; Department of Surgery, Maastricht University Medical Centre, Maastricht, Netherlands
| | | | - Michael J R Edwards
- Department of Surgery, Radboud University Medical Centre, Nijmegen, Netherlands
| | - Dennis den Hartog
- Department of Surgery, Erasmus University Medical Centre, Rotterdam, Netherlands
| | | | | | - Martijn Poeze
- Department of Surgery, Maastricht University Medical Centre, Maastricht, Netherlands; Network of Acute Care Limburg, Maastricht University Medical Centre+, Maastricht, Netherlands
| | - Luke P H Leenen
- Department of Surgery, University Medical Centre Utrecht, Utrecht, Netherlands
| | - Mark van Heijl
- Department of Surgery, University Medical Centre Utrecht, Utrecht, Netherlands; Department of Surgery, Diakonessenhuis Utrecht/Zeist/Doorn, Utrecht, Netherlands
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Follows A, Vassallo J. Paediatric major incident triage tools for identifying those in need of life-saving interventions. TRAUMA-ENGLAND 2020. [DOI: 10.1177/1460408619897517] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
A short cut review was carried out to establish whether existing paediatric major incident triage tools identify patients requiring life-saving interventions. Sixteen papers presented the best evidence to answer the clinical question. The author, date and country of publication, patient group studied, study type, relevant outcomes, results and study weaknesses of these papers are tabulated. In summary, there is limited evidence for the validity of existing paediatric major incident triage tools.
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Affiliation(s)
| | - Jamie Vassallo
- Emergency Department, Queen Alexandra Hospital, Portsmouth, UK
- Academic Department of Military Emergency Medicine, Royal Centre for Defence Medicine, Birmingham, UK
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Lerner EB, Studnek JR, Fumo N, Banerjee A, Arapi I, Browne LR, Ostermayer DG, Reynolds S, Shah MI. Multicenter Analysis of Transport Destinations for Pediatric Prehospital Patients. Acad Emerg Med 2019; 26:510-516. [PMID: 30343530 DOI: 10.1111/acem.13641] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2018] [Revised: 10/12/2018] [Accepted: 10/14/2018] [Indexed: 11/27/2022]
Abstract
BACKGROUND Although all emergency departments (EDs) should be ready to treat children, some may have illnesses or injuries that require higher-level pediatric resources that are not available at all hospitals. There are no national guidelines for emergency medical services (EMS) providers about when to directly transport children to hospitals with higher-level pediatric resources, with the exception of severe trauma. Variability exists in EMS protocols about when children warrant transport to hospitals with higher-level pediatric care. OBJECTIVE The objective was to determine how frequently pediatric patients are transported by EMS to hospitals with higher-level pediatric resources and to evaluate distribution patterns based on illness and injury severity. METHODS We conducted a retrospective analysis of all pediatric (age 0-18 years) transports in three large EMS systems between November 2014 and November 2016. Each community had a hospital with higher-level pediatric resources that was within a 30-minute transport time from any location. Patients were included if they were transported by ground ambulance and the request originated in the 9-1-1 system. We assessed the frequency of transports to a hospital with higher-level pediatric resources. Data were stratified by chief complaint of illness or injury and severity. Potential risk for severe injury was defined as meeting the physiologic step of the field triage guidelines and potential risk for severe illness was defined as having an abnormal vital sign after adjusting for patient age. RESULTS A total of 41,345 pediatric patients were transported by a participating EMS agency to an ED and had complete destination data. A total of 55% of all EMS-transported pediatric patients were transported to a hospital with higher-level pediatric resources. There was variation by site (range = 45%-71%) in the percentage of children who went to a hospital with higher-level pediatric resources. Patients over 15 years of age went to general EDs (57%) more often than younger patients. When stratified by severity, 60% of those with potentially severe illness and 74% of those with potentially severe trauma were transported to a hospital with higher-level pediatric resources. CONCLUSIONS EMS providers commonly transport children to hospitals with higher-level pediatric resources. However, more than one-quarter of children with potentially severe injuries and illnesses are transported to general EDs.
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Affiliation(s)
- E. Brooke Lerner
- Department of Emergency Medicine Medical College of Wisconsin Milwaukee WI
- Department of Pediatrics Section of Emergency Medicine Medical College of Wisconsin Milwaukee WI
| | | | - Nicole Fumo
- Department of Emergency Medicine Medical College of Wisconsin Milwaukee WI
| | - Anjishnu Banerjee
- Department of Emergency Medicine Medical College of Wisconsin Milwaukee WI
| | - Igli Arapi
- Department of Emergency Medicine Medical College of Wisconsin Milwaukee WI
| | - Lorin R. Browne
- Department of Pediatrics Section of Emergency Medicine Medical College of Wisconsin Milwaukee WI
| | | | | | - Manish I. Shah
- Department of Pediatrics Section of Emergency Medicine Baylor College of Medicine Houston TX
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Magnusson C, Herlitz J, Karlsson T, Axelsson C. Initial assessment, level of care and outcome among children who were seen by emergency medical services: a prospective observational study. Scand J Trauma Resusc Emerg Med 2018; 26:88. [PMID: 30340502 PMCID: PMC6194577 DOI: 10.1186/s13049-018-0560-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2018] [Accepted: 10/12/2018] [Indexed: 12/04/2022] Open
Abstract
Background The assessment of children in the Emergency Medical Service (EMS) is infrequent representing 5.4% of the patients in an urban area in the western part of Sweden. In Sweden, patients are assessed on scene by an EMS nurse whom independently decides on interventions and level of care. To aid the EMS nurse in the assessment a triage instrument, Rapid Emergency Triage and Treatment System-paediatrics (RETTS-p) developed for Emergency Department (ED) purpose has been in use the last 5 years. The aim of this study was to evaluate the EMS nurse assessment, management, the utilisation of RETTS-p and patient outcome. Methods A prospective, observational study was performed on 651 children aged < 16 years from January to December 2016. Statistical tests used in the study were Mann-Whitney U test, Fisher’s exact test and Spearman’s rank statistics. Results The dispatch centre indexed life-threatening priority in 69% of the missions but, of all children, only 6.1% were given a life threatening RETTS-p red colour by the EMS nurse. A total of 69.7% of the children were transported to the ED and, of these, 31.7% were discharged without any interventions. Among the non-conveyed patients, 16 of 197 (8.1%) visited the ED within 72 h but only two were hospitalised. Full triage, including five out of five vital signs measurements and an emergency severity index, was conducted in 37.6% of all children. A triage colour was not present in 146 children (22.4%), of which the majority were non-conveyed. The overall 30-day mortality rate was 0.8% (n = 5) in children 0–15 years. Conclusions Despite the incomplete use of all vital signs according to the RETTS-p, the EMS nurse assessment of children appears to be adapted to the clinical situation in most cases and the patients appear to be assessed to the appropriate level of care but indicating an over triage. It seems that the RETTS-p with full triage is used selectively in the pre-hospital assessment of children with a risk of death during the first 30 days of less than 1%.
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Affiliation(s)
- Carl Magnusson
- Department of Molecular and Clinical Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
| | - Johan Herlitz
- Department of Molecular and Clinical Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.,Pre Hospen-Centre for Prehospital Research, Faculty of Caring Science, Work Life and Social Welfare, University of Borås, Borås, Sweden
| | - Thomas Karlsson
- Health Metrics Unit, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Christer Axelsson
- Department of Molecular and Clinical Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.,Pre Hospen-Centre for Prehospital Research, Faculty of Caring Science, Work Life and Social Welfare, University of Borås, Borås, Sweden
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Differences in Prehospital Patient Assessments for Pediatric Versus Adult Patients. J Pediatr 2018; 199:200-205.e6. [PMID: 29759850 PMCID: PMC7073459 DOI: 10.1016/j.jpeds.2018.03.069] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2017] [Revised: 02/27/2018] [Accepted: 03/27/2018] [Indexed: 11/22/2022]
Abstract
OBJECTIVE To evaluate whether completion of vital signs assessments in pediatric transports by emergency medical services (EMS) differs by patient age. STUDY DESIGN We reviewed records by 20 agencies in a regional EMS system in Southwestern Pennsylvania between April 1, 2013 and December 31, 2016. We abstracted demographics, vital signs (systolic blood pressure, heart rate, respiratory rate), clinical, and transport characteristics. We categorized age as neonates (≤30 days), infants (1 month to <1 year), toddler (1 to <2 years), early childhood (2 to <6 years), middle childhood (6 to <12 years), adolescent (12 to <18 years), and adult (≥18 years). We used unadjusted and adjusted logistic regression to test if age group was associated with vital signs documentation, reporting of Glasgow Coma Scale and pain scale after trauma, and recording of oxygen saturation and breath sounds in respiratory complaints, using adults as the reference group. RESULTS In total, 371 746 cases (21 883 pediatric, 5.9%) were included. In adjusted analysis, most pediatric categories had reduced odds of complete vitals documentation (percent, OR, 95% CI): neonates (49.6%, 0.02, 0.02-0.03), infants (68.2%, 0.04, 0.03-0.04), toddlers (78.1%, 0.07, 0.06-0.07), early childhood (87.4%, 0.13, 0.12-0.15), and middle childhood (95.3%, 0.54, 0.46-0.63). Pain score documentation was lower in children after trauma (OR 0.80, 95%CI 0.76-0.85), and oxygen saturation documentation was lower in children with respiratory complaints (OR 0.20, 95%CI 0.18-0.25). CONCLUSIONS Pediatric patients were at increased risk of lacking vital signs documentation during prehospital care. This represents a critical area for education and quality improvement.
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van der Sluijs R, van Rein EAJ, Wijnand JGJ, Leenen LPH, van Heijl M. Accuracy of Pediatric Trauma Field Triage. JAMA Surg 2018; 153:671-676. [DOI: 10.1001/jamasurg.2018.1050] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Affiliation(s)
| | | | - Joep G. J. Wijnand
- Department of Surgery, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Luke P. H. Leenen
- Department of Surgery, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Mark van Heijl
- Department of Surgery, University Medical Center Utrecht, Utrecht, the Netherlands
- Department of Surgery, Diakonessenhuis Utrecht-Zeist-Doorn, Utrecht, the Netherlands
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