Division of Pediatric Surgery, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio 45229-3039, USA.
J Trauma Acute Care Surg. 2012 Aug;73(2):377-84; discussion 384. doi: 10.1097/TA.0b013e318259ca84.
The American College of Surgeons has defined six minimum activation criteria (ACS-6) for the highest level of trauma activations at trauma centers. The verification criteria also allow for the inclusion of additional criteria at the institution's discretion. The purpose of this prospective multicenter study was to evaluate the ACS-6 as well as commonly used activation criteria to evaluate overtriage and undertriage rates for pediatric trauma team activation.
Data were prospectively collected at nine pediatric trauma centers to examine 29 commonly used activation criteria. Patients meeting any of these criteria were evaluated for the use of high-level trauma resuscitation resources according to an expert consensus list. Patients requiring a resource but not meeting any activation criteria were included to evaluate undertriage rates.
During the 1-year study, a total of 656 patients were enrolled with a mean age of 8 years, a median Injury Severity Score of 14, and mortality of 11%. Using all criteria, 55% of patients would have been overtriaged and 9% would have been undertriaged. If only the ACS-6 were used, 24% of patients would have been overtriaged and 16% would have been undertriaged. Among activation criteria with more than 10 patients, those most predictive of using a high-level resource were a gunshot wound to the abdomen (92%), blood given before arrival (83%), traumatic arrest (83%), tachycardia/poor perfusion (83%), and age-appropriate hypotension (77%). The addition of tachycardia/poor perfusion and pretrauma center resuscitation with greater than 40 mL/kg results in eight criteria with an overtriage of 39% and an undertriage of 10.5%.
The ACS-6 provides a reliable overtriage or undertriage rate for pediatric patients. The inclusion of two additional criteria can further improve these rates while maintianing a simplified triage list for children.
美国外科医师学院已经为创伤中心的最高级别创伤激活定义了六个最低激活标准（ACS-6）。验证标准还允许机构自行决定纳入其他标准。本前瞻性多中心研究的目的是评估 ACS-6 以及常用的激活标准，以评估儿科创伤团队激活的过度分诊和分诊不足率。
在 9 个儿科创伤中心前瞻性收集数据，以检查 29 种常用的激活标准。根据专家共识清单，评估符合任何这些标准的患者是否使用高级创伤复苏资源。包括需要资源但不符合任何激活标准的患者，以评估分诊不足率。
在为期 1 年的研究中，共纳入 656 例患者，平均年龄为 8 岁，损伤严重程度评分中位数为 14，死亡率为 11%。使用所有标准，55%的患者将被过度分诊，9%的患者将被分诊不足。如果仅使用 ACS-6，则 24%的患者将被过度分诊，16%的患者将被分诊不足。在超过 10 例患者的激活标准中，最能预测使用高级资源的标准是腹部枪伤（92%）、到达前输血（83%）、创伤性骤停（83%）、心动过速/灌注不良（83%）和年龄适当的低血压（77%）。添加心动过速/灌注不良和创伤前中心复苏量大于 40 mL/kg 可使 8 个标准的过度分诊率为 39%，分诊不足率为 10.5%。
ACS-6 为儿科患者提供了可靠的过度分诊或分诊不足率。纳入另外两个标准可以在保持儿童简化分诊清单的同时进一步提高这些比率。
