Secondary Triage of the Injured Pediatric Patient within the Trauma Center: Support for a Selective Resource-Sparing Two-Stage System

Abstract

Objectives 

While it is generally agreed that pediatric trauma patients exposed to high-risk injury mechanisms should be sent to trauma centers, many patients seen with full trauma alerts are determined to have minimal injury. The purpose of this study was to develop and test a clinical tool to safely triage a group of pediatric trauma patients for initial evaluation by the emergency department (ED) within the trauma center.

Methods 

The pediatric trauma score (PTS) was used as the basis for development of a simplified, user-friendly assessment tool called the modified pediatric trauma score (mPTS). It used basic physiologic and anatomic signs identified at ED triage. This tool was retrospectively tested against the outcomes of 1112 pediatric trauma patients as determined by their final injury severity scores (ISS) and the need for urgent interventions.

Results 

Our tool would have triaged 58% of patients to ED preevaluaton resulting in significant resource savings. Concurrently, 99% of patients with an ISS greater than 10 and all patients who needed urgent interventions would have remained full trauma alert patients. The positive predictive value of our tool was only 0.32. indicating that a safe level of overtriage was maintained.

Conclusion 

This study serves as further support for the concept of multitiered triage systems within trauma centers. In such settings, initial evaluations of select pediatric patients can be safely performed by emergency medicine staff with deferral of full trauma team alerts.