Lee York Tien, Feng Xun Yi Jasmine, Lin Yea-Chyi, Chiang Li Wei
Department of Paediatric Surgery, KK Women's and Children's Hospital, Singapore.
Eur J Pediatr Surg. 2014 Feb;24(1):46-50. doi: 10.1055/s-0033-1349717. Epub 2013 Jul 12.
A regionalized trauma system must be tailored to the trauma epidemiology and the trauma care resources of the population it serves. Pediatric trauma system in Singapore differs from others because of its geographic compactness and relatively low incidence of severe trauma. The scarcity of polytrauma highlights the need of a reliable screening system to identify injured children who necessitate urgent transport to emergency department (ED) with pediatric resuscitation capacity as well as activation of trauma team upon their arrival. In this study, the validity of Pediatric Trauma Score (PTS), Glasgow Come Scale (GCS), and respiratory rate (RR) in identifying pediatric patients with major trauma and receipt of resuscitation is evaluated.
After obtaining Institutional Review Board approval, a retrospective analysis was performed using data obtained from our trauma registry between January 2011 and December 2012. Information pertaining to the demographics, causative mechanism, and injury description, resuscitation, admitting disciplines, surgical intervention, and outcome were analyzed. The sensitivity and specificity of PTS, GCS, and RR to predict outcomes of interest are calculated.
A total of 92 patients were recruited. From the 92 patients, 26 sustained major trauma, and 21 patients received ED resuscitation. The mean age was 4 years 9 months. Sensitivity and specificity of PTS ≤ 8, GCS ≤ 10, and abnormal RR for predicting major trauma were 61.5, 77.3; 26.9, 100; and 53.8, 60.6%; respectively. When the reliability to identify patients received ED resuscitation was evaluated the sensitivity and specificity of PTS ≤ 8, GCS ≤ 10, and abnormal RR were 90.5, 83.1; 28.6, 98.6; and 76.2, 66.2%; respectively.
The parameters of PTS need to be further refined to improve its accuracy and minimize the undertriage rate. If a combined physiologic and anatomic scoring system such as PTS is used, other physiologic parameters such as GCS and RR may become redundant. The evaluation of the validity of PTS, GCS, and RR in predicting pediatric major trauma indicated poor reliability.
区域创伤系统必须根据其所服务人群的创伤流行病学和创伤护理资源进行定制。新加坡的儿科创伤系统因其地域紧凑性和严重创伤发生率相对较低而与其他地区不同。多发伤病例的稀缺凸显了需要一个可靠的筛查系统，以识别那些需要紧急转运至具备儿科复苏能力的急诊科并在到达时启动创伤团队的受伤儿童。在本研究中，评估了儿科创伤评分（PTS）、格拉斯哥昏迷量表（GCS）和呼吸频率（RR）在识别患有严重创伤的儿科患者及接受复苏情况方面的有效性。
在获得机构审查委员会批准后，对2011年1月至2012年12月期间从我们的创伤登记处获取的数据进行了回顾性分析。分析了有关人口统计学、致病机制、损伤描述、复苏、收治科室情况、手术干预及结果等信息。计算了PTS、GCS和RR预测感兴趣结果的敏感性和特异性。
共纳入92例患者。在这92例患者中，26例遭受严重创伤，21例患者接受了急诊科复苏。平均年龄为4岁9个月。PTS≤8、GCS≤10及RR异常预测严重创伤的敏感性和特异性分别为61.5%、77.3%；26.9%、100%；53.8%、60.6%。当评估识别接受急诊科复苏患者的可靠性时，PTS≤8、GCS≤10及RR异常的敏感性和特异性分别为90.5%、83.1%；28.6%、98.6%；76.2%、66.2%。
PTS的参数需要进一步完善以提高其准确性并尽量降低漏诊率。如果使用诸如PTS这样的生理和解剖综合评分系统，其他生理参数如GCS和RR可能会变得多余。对PTS、GCS和RR预测儿科严重创伤有效性的评估表明其可靠性较差。
