Section of Emergency Medicine, Department of Pediatrics, Medical College of Wisconsin, Milwaukee, WI.
Section of Emergency Medicine, Department of Pediatrics, University of Texas-Southwestern, Dallas, TX.
Pediatr Emerg Care. 2024 Mar 1;40(3):187-190. doi: 10.1097/PEC.0000000000002995. Epub 2023 Jun 12.
Pediatric trauma centers use reports from emergency medical service providers to determine if a trauma team should be sent to the emergency department to prepare to care for the patient. Little scientific evidence supports the current American College of Surgeons (ACS) indicators for trauma team activation. The objective of this study was to determine the accuracy of the ACS Minimum Criteria for Full Trauma Team Activation for children as well as the accuracy of the modified criteria used at the local sites for trauma activation.
Emergency medical service providers who transported an injured child aged 15 years or younger to a pediatric trauma center in 1 of 3 cities were interviewed after emergency department arrival. Emergency medical service providers were asked if each of the activation indicators were present based on their evaluation. The need for full trauma team activation was determined through a medical record review using a published criterion standard definition. Undertriage and overtriage rates and positive likelihood ratios (+LRs) were calculated.
Emergency medical service provider interviews were conducted and outcome data were obtained for 9483 children. There were 202 (2.1%) cases that met the criterion standard for need for trauma team activation. Based on the ACS Minimum Criteria, 299 (3.0%) cases should have received a trauma activation. The ACS Minimum Criteria undertriaged 44.1% and overtriaged 20% (+LR, 27.9; 95% confidence interval, 23.1-33.7). Based on the actual activation status using the local criteria, 238 cases received a full trauma activation, 45% were undertriaged, and 1.4% were overtriaged (+LR, 40.1; 95% confidence interval, 32.4-49.7). There was 97% agreement between the ACS Minimum Criteria and the actual local activation status at the receiving institution.
The ACS Minimum Criteria for Full Trauma Team Activation for children have a high rate of undertriage. Changes that individual institutions have made to improve the accuracy of activations at their institutions seem to have had a limited effect on decreasing undertriage.
儿科创伤中心利用急救医疗服务提供者的报告来确定是否应派遣创伤小组前往急诊室准备救治患者。目前美国外科医师学院（ACS）的创伤小组激活指标几乎没有科学依据支持。本研究的目的是确定 ACS 充分创伤小组激活的最低标准对儿童的准确性，以及当地用于创伤激活的修改标准的准确性。
在 3 个城市中的 1 个城市，对将 15 岁或 15 岁以下受伤儿童送往儿科创伤中心的急救医疗服务提供者在到达急诊室后进行了采访。根据他们的评估，询问急救医疗服务提供者每个激活指标是否存在。通过使用已发布的标准定义的病历回顾确定是否需要充分的创伤小组激活。计算分诊不足和分诊过度的发生率和阳性似然比（+LR）。
对 9483 名儿童进行了急救医疗服务提供者访谈并获得了结局数据。有 202 例（2.1%）符合创伤小组激活的标准标准。根据 ACS 最低标准，有 299 例（3.0%）应接受创伤激活。ACS 最低标准分诊不足 44.1%，过度分诊 20%（+LR，27.9；95%置信区间，23.1-33.7）。根据当地标准的实际激活状态，有 238 例接受了充分的创伤激活，45%被分诊不足，1.4%被分诊过度（+LR，40.1；95%置信区间，32.4-49.7）。ACS 最低标准和接收机构的实际本地激活状态之间有 97%的一致性。
儿童充分创伤小组激活的 ACS 最低标准有很高的分诊不足率。个别机构为提高其机构激活的准确性所做的更改似乎对减少分诊不足的影响有限。
