From the Division of Pediatric Surgery, Department of Surgery (M.C.M., L.V., A.G.), University of Tennessee Health Science Center, Memphis, Tennessee; Department of Preventive Medicine (R.V.B.), Keck School of Medicine, University of Southern California, Los Angeles, California; Institute of Health and Equity, Department of Epidemiology (L.D.C., E.M.), Medical College of Wisconsin, Milwaukee, Wisconsin; Cohen Children's Medical Center (N.C.), New Hyde Park, New York; Division of Pediatric Surgery (A.C., M.J.), Doernbecher Children's Hospital, Oregon Health and Science University; Division of Pediatric Surgery (A.C., M.J.), Randall Children's Hospital, Legacy Emanuel Medical Center, Portland, Oregon; Wolfson Children's Hospital (K.L.), University of Florida, Jacksonville, Florida; Division of Pediatric Surgery (N.Y.), University of Calgary, Calgary, Alberta; Children's Foundation Research Institute (A.G.), Le Bonheur Children's Hospital, Memphis, Tennessee; and Health Sciences Library (L.W.), University of Tennessee Health Science Center, Memphis, Tennessee.
J Trauma Acute Care Surg. 2020 Oct;89(4):623-630. doi: 10.1097/TA.0000000000002713.
Significant variability exists in the triage of injured children with most systems using mechanism of injury and/or physiologic criteria. It is not well established if existing triage criteria predict the need for intervention or impact morbidity and mortality. This study evaluated existing evidence for pediatric trauma triage. Questions defined a priori were as follows: (1) Do prehospital trauma triage criteria reduce mortality? (2) Do prehospital trauma scoring systems predict outcomes? (3) Do trauma center activation criteria predict outcomes? (4) Do trauma center activation criteria predict need for procedural or operative interventions? (5) Do trauma bay pediatric trauma scoring systems predict outcomes? (6) What secondary triage criteria for transfer of children exist?
A structured, systematic review was conducted, and multiple databases were queried using search terms related to pediatric trauma triage. The literature search was limited to January 1990 to August 2019. Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) methodology was applied with the methodological index for nonrandomized studies tool used to assess the quality of included studies. Qualitative analysis was performed.
A total of 1,752 articles were screened, and 38 were included in the qualitative analysis. Twelve articles addressed questions 1 and 2, 21 articles addressed question 3 to 5, and five articles addressed question 6. Existing literature suggest that prehospital triage criteria or scoring systems do not predict or reduce mortality, although selected physiologic parameters may. In contrast, hospital trauma activation criteria can predict the need for procedures or surgical intervention and identify patients with higher mortality; again, physiologic signs are more predictive than mechanism of injury. Currently, no standardized secondary triage/transfer protocols exist.
Evidence supporting the utility of prehospital triage criteria for injured children is insufficient, while physiology-based trauma system activation criteria do appropriately stratify injured children. The absence of strong evidence supports the need for further prehospital and secondary transfer triage-related research.
Systematic review study, level II.
大多数创伤儿童分诊系统使用创伤机制和/或生理标准，其差异较大。目前尚不清楚现有的分诊标准是否能预测干预需求或对发病率和死亡率产生影响。本研究评估了现有的儿科创伤分诊证据。预先定义的问题如下：(1) 院前创伤分诊标准能否降低死亡率？(2) 院前创伤评分系统能否预测结局？(3) 创伤中心激活标准能否预测结局？(4) 创伤中心激活标准能否预测是否需要进行有创或手术干预？(5) 创伤抢救室儿科创伤评分系统能否预测结局？(6) 儿童转院的其他次要分诊标准有哪些？
采用结构化系统评价方法，使用与儿科创伤分诊相关的检索词检索多个数据库。文献检索时间范围限定为 1990 年 1 月至 2019 年 8 月。采用系统评价和荟萃分析首选报告项目(PRISMA)方法学，并使用非随机研究方法学质量指数工具评估纳入研究的质量。进行定性分析。
共筛选出 1752 篇文章，其中 38 篇文章纳入定性分析。12 篇文章回答了问题 1 和 2，21 篇文章回答了问题 3 至 5，5 篇文章回答了问题 6。现有文献表明，虽然某些生理参数可能具有预测作用，但院前分诊标准或评分系统并不能预测或降低死亡率。相比之下，医院创伤激活标准可以预测是否需要手术干预，也可以识别死亡率较高的患者；同样，生理指标比创伤机制更具预测性。目前，没有标准化的二次分诊/转院协议。
支持院前分诊标准用于创伤儿童的证据不足，而基于生理学的创伤系统激活标准可适当对创伤儿童进行分层。由于缺乏强有力的证据，需要进一步开展院前和二级转院相关分诊研究。
系统评价研究，Ⅱ级。
