Phoenix Children's Hospital, Department of Emergency Medicine.
Children's Hospital, New Orleans, Department of Emergency Medicine.
J Pediatr Surg. 2020 Sep;55(9):1761-1765. doi: 10.1016/j.jpedsurg.2019.09.032. Epub 2019 Oct 24.
In previous studies, SIPA was shown to be better than the SI in identifying children who have an elevated ISS, required transfusion, or were at a high risk of death. No comparison has been made to the consensus-based criteria that identify patients requiring the highest-level trauma activation. The objective of this study was to determine if the SIPA was more accurate than the SI in identifying children with increased need for trauma team activation as defined by the criterion standard definition, and secondly the sensitivity and specificity of the SI and SIPA.
Retrospective review of prospectively collected trauma based data. Children aged 1-17 years admitted to a pediatric level 1 trauma center between 1/1/16 and 12/31/17 and met the prehospital criteria for level 1 or 2 trauma activation were included. We evaluated the ability of SI > 0.9 at ED presentation and elevated SIPA to predict need for trauma activation based on consensus criteria. SIPA cutoffs were > 1.22 (age 4-6), >1.0 (age 7-12), and > 0.9 (age 13-17).
Among 3378 children, 1486 (44%) had an elevated SI and 590 (18%) had an elevated SIPA. There were 160 (5%) patients who met at least one consensus criterion. Broadly, sensitivity and specificity analyses reveal poor sensitivity for both SI and SIPA (59.4% versus 43.1% respectively) measures but a moderate specificity for SIPA (83.8%). Both SI and SIPA have a poor PPV (6.4% versus 11.7%) but high NPV (96.6% versus 96.7%). Overall, SIPA has higher accuracy than SI in predicting consensus criteria 82% versus 57%).
SIPA is more accurate than the SI in identifying children who meet a consensus criterion defining the need for highest-level trauma activation. The low PPV and sensitivity suggest that SIPA alone, while somewhat less likely to lead to overtriage than SI is not ideal for ruling in the need for level one resources as defined by the consensus criteria. Prognosis study, retrospective.
Level II.
在之前的研究中，SIPA 被证明优于 SI，可用于识别 ISS 升高、需要输血或死亡风险高的儿童。目前尚未将其与基于共识的标准进行比较，后者用于确定需要最高级别创伤激活的患者。本研究的目的是确定 SIPA 是否比 SI 更能准确识别符合标准定义的创伤团队激活需求增加的儿童，其次是 SI 和 SIPA 的灵敏度和特异性。
回顾性分析前瞻性收集的创伤基础数据。纳入 2016 年 1 月 1 日至 2017 年 12 月 31 日期间在儿科一级创伤中心就诊且符合院前一级或二级创伤激活标准的 1-17 岁儿童。我们评估了 ED 就诊时 SI>0.9 和升高的 SIPA 预测基于共识标准的创伤激活需求的能力。SIPA 截断值分别为>1.22（4-6 岁）、>1.0（7-12 岁）和>0.9（13-17 岁）。
在 3378 名儿童中，1486 名（44%）SI 升高，590 名（18%）SIPA 升高。有 160 名（5%）患者至少符合一个共识标准。总体而言，SI 和 SIPA 的敏感性和特异性分析均显示出较低的敏感性（分别为 59.4%和 43.1%），但 SIPA 的特异性较高（83.8%）。SI 和 SIPA 的 PPV 均较低（分别为 6.4%和 11.7%），但 NPV 较高（分别为 96.6%和 96.7%）。总体而言，SIPA 预测符合共识标准的准确性高于 SI（82%对 57%）。
SIPA 比 SI 更能准确识别符合共识标准定义的需要最高级别创伤激活的儿童。较低的 PPV 和敏感性表明，SIPA 虽然不太可能导致过度分诊，但不能单独用于根据共识标准确定一级资源的需求。预后研究，回顾性。
二级。
