Dowd M D, McAneney C, Lacher M, Ruddy R M
Division of Emergency Medicine, Children's Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, OH, USA.
Acad Emerg Med. 2000 Oct;7(10):1119-25. doi: 10.1111/j.1553-2712.2000.tb01261.x.
Care of the severely injured child requires the rapid assembly of personnel trained in pediatric trauma care. Trauma team activation criteria, which are highly sensitive and maximally specific for identifying the child who requires resuscitation, are necessary to provide rapid care to all who need it, while using resources efficiently.
To determine the sensitivity and specificity of the standard trauma team activation (TTA) criteria for identifying patients who receive resuscitation in the emergency department.
A one-year study was conducted of all patients transported by emergency medical out-of-hospital services for a trauma-related complaint. For all patients, out-of-hospital medical control operators recorded whether patients met TTA criteria and, if so, which criteria were met. Criteria included standard physiologic, anatomic, and mechanism parameters. Sensitivity and specificity for the outcome of resuscitation (volume restoration, assisted ventilation or intubation, chest tube insertion/needle decompression, operative intervention) were calculated.
A total of 492 patients met the case definition. Two-thirds were male, the mean age was 8 years (+/-4.8 SD), and the Injury Severity Score was > or =15 in 9.3%. Trauma team activation criteria were met by 179 patients (36. 4%) and, of these, 107 met mechanism criteria only. A resuscitative intervention was received by 54 (10.9%) of the total and none in the mechanism-only group. Sensitivity and specificity of the TTA criteria for predicting receipt of a resuscitation procedure were 98. 1% and 71.2%, respectively. When mechanism criteria were excluded, the sensitivity remained 98.1% and the specificity increased to 95. 7%.
Criteria for TTA that include patients who meet mechanism criteria only are not specific for identifying patients who receive a resuscitative intervention. Use of anatomic and physiologic criteria only results in an increase in specificity, thereby reducing overtriage while retaining a high sensitivity.
救治重伤儿童需要迅速召集受过儿科创伤护理培训的人员。创伤团队启动标准对于识别需要复苏的儿童具有高度敏感性和最大特异性，这对于为所有需要的人提供快速护理并有效利用资源是必要的。
确定标准创伤团队启动（TTA）标准用于识别在急诊科接受复苏患者的敏感性和特异性。
对所有因创伤相关主诉由院外急救医疗服务转运的患者进行了为期一年的研究。对于所有患者，院外医疗控制操作员记录患者是否符合TTA标准，若符合，符合哪些标准。标准包括标准生理、解剖和机制参数。计算复苏结果（容量恢复、辅助通气或插管、胸腔闭式引流/针减压、手术干预）的敏感性和特异性。
共有492例患者符合病例定义。三分之二为男性，平均年龄8岁（标准差4.8），9.3%的患者损伤严重程度评分≥15分。179例患者（36.4%）符合创伤团队启动标准，其中107例仅符合机制标准。总计54例（10.9%）接受了复苏干预，仅符合机制标准组无人接受。TTA标准预测接受复苏程序的敏感性和特异性分别为98.1%和71.2%。排除机制标准后，敏感性仍为98.1%，特异性增至95.7%。
仅包括符合机制标准患者的TTA标准对于识别接受复苏干预的患者不具有特异性。仅使用解剖和生理标准会提高特异性，从而减少过度分诊，同时保持高敏感性。
