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      Evaluation of the Pediatric Trauma Triage Checklist as a Prehospital Pediatric Trauma Triage Tool for the State of Florida

      Prehospital and Disaster Medicine
      Cambridge University Press (CUP)

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          Abstract

          Introduction:

          Triage of injured children poses a significant challenge for prehospital-care providers because there is no single trauma triage tool in use that has been developed specifically for children. The pediatric trauma score (PTS) probably is the single most studied and tested trauma triage tool developed solely for the pediatric population, and is an effective predictor of both severity of injury and potential mortality in injured children. However, the pediatric trauma score has been found to be an ineffective prehospital triage tool because it is not “user friendly” for field personnel. As such, the PTS has been modified to generate the more user-friendly ”pediatric trauma triage checklist (PTTC).”

          Methods:

          This study retrospectively reviewed 106 prehospital run reports to determine whether the patient met one or more of the criteria in the PTTC. By applying the MacKenzie algorithm to outcome data for each case, it was possible to determine whether the patient should have been sent to a trauma center.

          Results:

          The PTTC demonstrated a sensitivity of 86.2%, a specificity of 41.6%, and an accuracy of 66.0%. The PTTC demonstrate an overtriage rate of 58.3% and an under-triage rate of 13.8%. When compared with a previous study, the PTTC demonstrated a 74 % increase in overtriage. However, the 59% reduction in undertriage is more important.

          Conclusions:

          Use of the PTTC appears to have merit as a pediatric prehospital trauma triage tool but further study is recommended. The PTTC should be tested in a prospective, multiregional study involving a sample size sufficient to reach statistical significance.

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          Most cited references8

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          A rapid method for estimating weight and resuscitation drug dosages from length in the pediatric age group.

          Drug dosages used during pediatric emergencies and resuscitation are often based on estimated body weight. The Broselow Tape, a tape measure that estimates weight and drug dosages for pediatric patients from their length, has been developed to facilitate proper dosing during emergencies. In our study, 937 children of known weight were measured with this tape. Weight estimates generated by the tape were found to be within 15% error for 79% of the children. The tape was found to be extremely accurate for children from 3.5 to 10 kg, and from 10 to 25 kg. Regression lines of estimated compared with actual weight for these children have slopes of 0.98 and 0.96, respectively, not significantly different from the ideal slope of 1.00 (P = 28 and .13). Accuracy was significantly decreased for measured children who weighed more than 25 kg. In a separate group of children (n = 53), the tape was shown to be more accurate than weight estimates made by residents and pediatric nurses (P less than .0001). Use of the Broselow Tape is a simple, accurate method of estimating pediatric weights and drug doses and eliminates the need for memorization and calculation.
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            The Pediatric Trauma Score as a predictor of injury severity: an objective assessment.

            The ability of the Pediatric Trauma Score (P.T.S.) to predict injury severity and mortality was evaluated by analysis of its relationship with the Injury Severity Score (I.S.S.) of 615 children entered into the National Pediatric Trauma Registry (N.P.T.R.). Mean age was 8.2 years and mortality was 3.5%. Mean I.S.S. of survivors was 8.1 in comparison to 59.7 for nonsurvivors. Linear regression coefficient determined from analysis of these variables produced a slope of -3.7 with a statistically significant correlation of P.T.S. to I.S.S. (p less than 0.001; r2 = 0.89). Analysis of the mortality for each cohort of patients with the same P.T.S. identified three categories of mortality potential. Children whose P.T.S. was greater than 8 had a 0% mortality. Children whose P.T.S. was between 0 and 8 had an increasing mortality related to their decreasing P.T.S. (r2 = 0.86), and children whose P.T.S. was below 0 had 100% mortality. This study documents the direct linear relationship between P.T.S. and injury severity, and confirms the P.T.S. as an effective predictor of both severity of injury and potential for mortality.
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              A comparison of the trauma score, the revised trauma score, and the pediatric trauma score.

              We compared the abilities of the Trauma Score (TS), the Revised Trauma Score (RTS), and the Pediatric Trauma Score (PTS) to retrospectively identify severely injured children. TS, RTS, and PTS were computed on admission for 1,334 consecutive blunt and penetrating trauma victims 0 to 14 years old. Injury Severity Score values of more than 15 and 20 or more were used as the criteria indicating severe injury. Sensitivity, specificity, and positive and negative predictive values were computed. Threshold values were determined for each scale to maximize sensitivity and specificity. No significant differences were found between the TS and the PTS. After adjusting for rapid respirations among children 0 to 3 years old, no differences existed between the RTS and the other scores. TS of less than 15, RTS of less than 12, and PTS of less than 9 are equally sensitive and specific indicators for pediatric prehospital triage. Because of the similarity of the instruments tested, their performances in other areas, such as quality assurance, should be considered when selecting a pediatric triage tool.
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                Author and article information

                Journal
                applab
                Prehospital and Disaster Medicine
                Prehosp. Disaster med.
                Cambridge University Press (CUP)
                1049-023X
                1945-1938
                March 1996
                June 28 2012
                March 1996
                : 11
                : 01
                : 20-26
                Article
                10.1017/S1049023X00042308
                e181b240-ee7b-4a40-b0df-5e5126664a2b
                © 1996
                History

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