Pediatric Trauma Society

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Pre-Hospital Factors that Predict the Need for Early Surgeon Presence in the Setting of Pediatric Trauma
Paul McGaha, II, MD; Tabitha Garwe, PhD; Zoona Sarwar, MS; Justin Robbins, BS; Robert Letton, MD
University of Oklahoma Health Science Center, Oklahoma City, OK

Background: Evidence based variables predicting the need for surgeon presence on arrival of an injured child are limited. We sought to identify pre-hospital factors that best correlate with the need for surgeon presence (NSP). A secondary analysis was also performed to determine whether injury severity score (ISS) was predictive of NSP.

Methods:
This was a retrospective study of injured patients age ? 16 years delivered from scene to a Pediatric Level I trauma center between January 2016 and June 2017. 229 patients had complete pre-hospital data available for analysis. NSP was previously described as the presence of any of these factors: intubation, transfusion, operating room, pressors, interventional radiology, spinal cord Injury, chest tube, emergency department thoracotomy, intracranial pressure monitor, pericardiocentesis, or death in the trauma bay. Multivariable analysis was performed with covariates of interest including scene and ED arrival vitals and interventions.

Results:
Independent predictors of NSP were GCS of < 13 (OR 5.87), penetrating trauma (OR 5.63), age 7-12 years (OR 4.13), SBP < 90mmHg (OR 4.04), and tachycardia (OR 3.65). We also found that ISS ? 16 was a poor threshold for predicting NSP with a sensitivity of only 59%.

Conclusion:
A model based on these variables may be useful in predicting NSP prior to arrival of pediatric trauma patients. As ISS ? 16 had a poor sensitivity for NSP, current matrices based on ISS to determine over and under triage may be inaccurate in pediatric trauma patients. Prospective studies are needed to develop better models of triage.


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