Pediatric Trauma Triage: A PTS Research Committee Systematic Review
Carmen Mora1, Laura Veras1, *Rita Burke2, *Laura Cassidy3, *Nathan Christopherson4, Aaron Cunningham5, *Mubeen Jafri5, *Katie Leavitt6, *Karen Lidsky7, Lin Wu1, *Natalie Yanchar8, *Ankush Gosain1
1University of Tennessee HSC-Le Bonheur Children's, Memphis, TN;2University of Southern California/CHLA, Los Angeles, CA;3Medical College of Wisconsin, Milwaukee, WI;4Northwell Health, New Hyde Park, NY;5Oregon Health & Science University, Portland, OR;6PRRI Inc, Beverly, MA;7University Hospitals of Cleveland, Cleveland, OH;8Alberta Children's Hospital, Calgary, AB, Canada
PURPOSE Significant variability exists in the triage of injured children with most systems using mechanism of injury and/or physiologic criteria. We sought to evaluate existing evidence for pediatric trauma triage. Questions defined were: 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. METHODS Multiple databases were queried using search terms related to pediatric trauma triage. Literature search was limited to January 1990 to December 2016. PRISMA methodology was applied with the MINORS tool used to score the quality of studies deemed relevant. Qualitative analysis was performed. Figure 1 RESULTS Twelve articles addressed questions 1 and 2. Twenty articles addressed question 3-5. Existing literature suggest that pre-hospital triage criteria or scoring systems don't predict or reduce mortality, although selected physiologic parameters may. In contrast, trauma activation criteria can predict the need for procedures or surgical intervention and identify patients with higher mortality. Physiologic signs are more predictive than mechanism of injury. CONCLUSIONS Evidence supporting the utility of pre-hospital 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 triage-related research.
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