Zagory Jessica A, Wieck Minna M, Lerner Brooke E, Moody Suzanne, Falcone Richard A, Burke Rita V
Medical College of Wisconsin.
Cincinnati Children's Hospital Medical Center.
Pediatr Emerg Care. 2018 Nov;34(11):787-790. doi: 10.1097/PEC.0000000000001178.
Despite the presence of a tiered in-hospital trauma triage system for the past decade, trauma centers still struggle with a definitive list of highest level activation criteria. In 2002, the American College of Surgeons (ACS) mandated 6 criteria for highest level activation. However, it is unknown if pediatric trauma centers follow these criteria. The purpose of this study is to identify and categorize the highest level pediatric trauma criteria used by pediatric trauma centers in the United States.
In collaboration with the ACS, we reviewed activation criteria for highest level trauma activation for all ACS-verified level I pediatric trauma centers in the United States. Criteria were sorted by 2 reviewers into categories of indicators used for activation: patient demographic, physiologic, anatomic, intervention/resource usage, mechanism, and other.
A total of 51 unique criteria for highest level trauma activation were identified from 54 (96%) of 56 level I pediatric trauma centers. Each center used between 1 and 29 criteria. A total of 42.6% of pediatric trauma centers followed all 6 criteria recommended by ACS. The most commonly omitted criterion was emergency physician discretion. The most common criteria not included in the ACS recommendations, but included in the highest level activation criteria, were amputation proximal to wrist or ankle (63%), and spinal cord injury/paralysis (63%).
There is wide variation in the criteria used for highest level trauma activation among pediatric trauma centers. Further research investigating individual or grouped criteria to determine the most sensitive and specific criteria are necessary for appropriate triage and resource usage.
尽管在过去十年中存在分层的院内创伤分诊系统，但创伤中心仍在为确定最高级别激活标准的最终清单而苦苦挣扎。2002年，美国外科医师学会（ACS）规定了6项最高级别激活标准。然而，尚不清楚儿科创伤中心是否遵循这些标准。本研究的目的是识别和分类美国儿科创伤中心使用的最高级别儿科创伤标准。
我们与美国外科医师学会合作，审查了美国所有经该学会验证的一级儿科创伤中心最高级别创伤激活的标准。两位评审员将标准按用于激活的指标类别进行分类：患者人口统计学、生理学、解剖学、干预/资源使用、机制及其他。
在56家一级儿科创伤中心中的54家（96%）共识别出51项最高级别创伤激活的独特标准。每个中心使用1至29项标准。共有42.6%的儿科创伤中心遵循了美国外科医师学会推荐的所有6项标准。最常被遗漏的标准是急诊医生的判断。美国外科医师学会建议中未包括但包含在最高级别激活标准中的最常见标准是腕部或踝部近端截肢（63%）以及脊髓损伤/瘫痪（63%）。
儿科创伤中心在最高级别创伤激活所使用的标准方面存在很大差异。有必要进一步研究个体或分组标准，以确定最敏感和特异的标准，以便进行适当的分诊和资源使用。
