Skip to main content
SpringerLink
Log in

Do prehospital criteria optimally assign injured children to the appropriate level of trauma team activation and emergency department disposition at a level I pediatric trauma center?

  • Original Article
  • Published:
Pediatric Surgery International Aims and scope Submit manuscript

Abstract

Purpose

To examine the association of prehospital criteria with the appropriate level of trauma team activation (TTA) and emergency department (ED) disposition among injured children at a level I pediatric trauma center.

Methods

Injured children younger than 15 years and transported by emergency medical services (EMS) from the scene of injury between January 1, 2008 and December 31, 2011 were identified using the institution’s trauma registry. Logistic regression was used to study the main outcomes of interest, full TTA (FTTA) and ED disposition.

Results

Out of 3,213 children, 1,991 were eligible and analyzed. Only 279 children initiated the FTTA and 73.9 % were admitted. Having a chest injury, abnormal heart rate or Glasgow Coma Scale less than 9 (GCSLT9) in the field was associated with higher odds of initiating the FTTA (odds ratio [OR] = 3.33, 95 % confidence interval [CI] 1.54–7.20; OR = 2.59, CI 1.15–5.79 and OR = 2.67, CI 1.14–6.22, respectively). Children with the criteria above in addition to abdominal injury were more likely to be discharged to the ICU, OR or morgue compared to those without them.

Conclusion

Children with GCSLT9, abnormal heart rate, chest and abdominal injury showed a strong association with FTTA and higher resource utilization.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

References

  1. CDC W (2014) National Center for injury prevention and control. Ten leading causes of death injury.10-15-2012

  2. Kohn MA, Hammel JM, Bretz SW et al (2004) Trauma team activation criteria as predictors of patient disposition from the emergency department. Acad Emerg Med 11(1):1–9

    Article  PubMed  Google Scholar 

  3. Stafford PW, Blinman TA, Nance ML (2002) Practical points in evaluation and resuscitation of the injured child. Surg Clin North Am 82(2):273–301

    Article  PubMed  Google Scholar 

  4. Kouzminova N, Shatney C, Palm E et al (2009) The efficacy of a two-tiered trauma activation system at a level I trauma center. J Trauma 67(4):829–833

    Article  PubMed  Google Scholar 

  5. Sola JE, Scherer LR, Haller JA Jr et al (1994) Criteria for safe cost-effective pediatric trauma triage: prehospital evaluation and distribution of injured children. J Pediatr Surg 29(6):738–741

    Article  PubMed  CAS  Google Scholar 

  6. Nuss KE, Dietrich AM, Smith GA (2001) Effectiveness of a pediatric trauma team protocol. Pediatr Emerg Care 17(2):96–100

    Article  PubMed  CAS  Google Scholar 

  7. Phillips JA, Buchman TG (1993) Optimizing prehospital triage criteria for trauma team alerts. J Trauma 34(1):127–132

    Article  PubMed  CAS  Google Scholar 

  8. Haller JA Jr (2002) The evolution and current status of emergency medical services for children. Surg Clin North Am 82(2):263–264

    Article  PubMed  Google Scholar 

  9. Knofsky M, Burns JB Jr, Chesire D et al (2013) Pediatric trauma patients are more likely to be discharged from the emergency department after arrival by helicopter emergency medical services. J Trauma Acute Care Surg 74(3):917–920

    Article  PubMed  Google Scholar 

  10. Falcone RA Jr, Daugherty M, Schweer L et al (2008) Multidisciplinary pediatric trauma team training using high-fidelity trauma simulation. J Pediatr Surg 43(6):1065–1071

    Article  PubMed  Google Scholar 

  11. Falcone RA Jr, Haas L, King E et al (2012) A multicenter prospective analysis of pediatric trauma activation criteria routinely used in addition to the six criteria of the American College of Surgeons. J Trauma Acute Care Surg 73(2):377–384

    Article  PubMed  Google Scholar 

  12. Badawi O, Breslow MJ (2012) Readmissions and death after ICU discharge: development and validation of two predictive models. PLoS One 7(11):e48758

    Article  PubMed  CAS  PubMed Central  Google Scholar 

  13. Sasser SM, Hunt RC, Sullivent EE et al (2009) Guidelines for field triage of injured patients. Recommendations of the National Expert Panel on Field Triage. MMWR Recomm Rep 58(RR-1):1–35

    PubMed  Google Scholar 

  14. Mace SE, Sharieff G, Bern A et al (2010) Pediatric issues in disaster management, part 1: the emergency medical system and surge capacity. Am J Disaster Med 5(2):83–93

    Article  PubMed  Google Scholar 

  15. Sasser SM, Hunt RC, Faul M et al (2012) Guidelines for field triage of injured patients: recommendations of the National Expert Panel on Field Triage, 2011. MMWR Recomm Rep 61(RR-1):1–20

    PubMed  Google Scholar 

  16. Lehmann R, Brounts L, Lesperance K et al (2009) A simplified set of trauma triage criteria to safely reduce overtriage: a prospective study. Arch Surg 144(9):853–858

    Article  PubMed  Google Scholar 

  17. van der Palm DW, van der Ark LA, Vermunt JK (2012) A comparison of incomplete-data methods for categorical data. Stat Methods Med Res

Download references

Author information

Authors and Affiliations

  1. University of Arkansas for Medical Sciences, College of Medicine, Department of Pediatrics, Little Rock, AR, USA

    Rosemary Nabaweesi

  2. University of Arkansas for Medical Sciences, College of Public Health, Little Rock, AR, USA

    Stephen M. Bowman

  3. Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA

    Laura Morlock & Andrea Gielen

  4. Johns Hopkins Hospital, Baltimore, MD, USA

    Charles Lule & Susan Ziegfeld

  5. Johns Hopkins University, School of Medicine, Department of General Pediatric Surgery, Baltimore, MD, USA

    Paul M. Colombani

Authors
  1. Rosemary Nabaweesi
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Laura Morlock
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Charles Lule
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Susan Ziegfeld
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Andrea Gielen
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Paul M. Colombani
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Stephen M. Bowman
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Rosemary Nabaweesi.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Nabaweesi, R., Morlock, L., Lule, C. et al. Do prehospital criteria optimally assign injured children to the appropriate level of trauma team activation and emergency department disposition at a level I pediatric trauma center?. Pediatr Surg Int 30, 1097–1102 (2014). https://doi.org/10.1007/s00383-014-3587-6

Download citation

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00383-014-3587-6

Keywords

Search

Navigation