Cohen Neta, Davis Adrienne L, Test Gidon, Singer-Harel Dana, Pasternak Yehonatan, Beno Suzanne, Scolnik Dennis
Division of Paediatric Emergency Medicine, Department of Paediatrics, SickKids, University of Toronto, Toronto, Ontario, Canada.
Division of Clinical Immunology and Allergy, Department of Paediatrics, SickKids, University of Toronto, Toronto, Ontario, Canada.
Paediatr Child Health. 2022 Oct 13;28(1):17-23. doi: 10.1093/pch/pxac085. eCollection 2023 Feb.
To explore the optimal set of trauma activation criteria predicting paediatric patients' need for acute care following multi-trauma, with particular attention to Glasgow Coma Scale (GCS) cut-off value.
A retrospective cohort study of paediatric multi-trauma patients aged 0 to 16 years, performed at a Level 1 paediatric trauma centre. Trauma activation criteria and GCS levels were examined with respect to patients' need for acute care, defined as: direct to operating room disposition, intensive care unit admission, need for acute interventions in the trauma room, or in-hospital death.
We enrolled 436 patients (median age 8.0 years). The following predicted need for acute care: GCS <14 (adjusted odds ratio [aOR] 23.0, 95% confidence interval [CI]: 11.5 to 45.9, P < 0.001), hemodynamic instability: (aOR 3.7, 95% CI: 1.2-8.1, P = 0.01), open pneumothorax/flail chest (aOR: 20.0, 95% CI: 4.0 to 98.7, P < 0.001), spinal cord injury (aOR 15.4, 95% CI; 2.4 to 97.1, P = 0.003), blood transfusion at the referring hospital (aOR: 7.7, 95% CI: 1.3 to 44.2, P = 0.02) and GSW to the chest, abdomen, neck, or proximal extremities (aOR 11.0, 95% CI; 1.7 to 70.8, P = 0.01). Using these activation criteria would have decreased over- triage by 10.7%, from 49.1% to 37.2% and under-triage by 1.3%, from 4.7% to 3.5%, in our cohort of patients.
Using GCS<14, hemodynamic instability, open pneumothorax/flail chest, spinal cord injury, blood transfusion at the referring hospital, and GSW to the chest, abdomen, neck of proximal extremities, as T1 activation criteria could decrease over- and under-triage rates. Prospective studies are needed to validate the optimal set of activation criteria in paediatric patients.
探讨预测多发伤患儿急性护理需求的最佳创伤激活标准组合，尤其关注格拉斯哥昏迷量表（GCS）的临界值。
在一家一级儿科创伤中心对0至16岁的儿科多发伤患者进行回顾性队列研究。根据患者对急性护理的需求来检查创伤激活标准和GCS水平，急性护理需求定义为：直接进入手术室处置、入住重症监护病房、在创伤室需要急性干预或院内死亡。
我们纳入了436例患者（中位年龄8.0岁）。以下因素可预测急性护理需求：GCS<14（调整优势比[aOR]23.0，95%置信区间[CI]：11.5至45.9，P<0.001）、血流动力学不稳定（aOR 3.7，95%CI：1.2 - 8.1，P = 0.01）、开放性气胸/连枷胸（aOR：20.0，95%CI：4.0至98.7，P<0.001）、脊髓损伤（aOR 15.4，95%CI；2.4至97.1，P = 0.003）、在转诊医院输血（aOR：7.7，95%CI：1.3至44.2，P = 0.02）以及胸部、腹部、颈部或近端肢体的枪伤（aOR 11.0，95%CI；1.7至70.8，P = 0.01）。在我们的患者队列中，使用这些激活标准可使过度分诊减少10.7%，从49.1%降至37.2%，使漏诊减少1.3%，从4.7%降至3.5%。
将GCS<14、血流动力学不稳定、开放性气胸/连枷胸、脊髓损伤、在转诊医院输血以及胸部、腹部、颈部或近端肢体的枪伤作为T1激活标准可降低过度分诊和漏诊率。需要进行前瞻性研究以验证儿科患者最佳激活标准组合。
