Proposed Objectives: The objective of this study is to validate the Field Triage Decision Scheme for injured pediatric patients. Specifically, as required by the RFA, this study will evaluate a component of the trauma system, prehospital triage, which contributes to improved outcomes for acutely injured persons through the evaluation of the impact of prehospital care on overall trauma care and outcome (option 2, criteria d and e). Importance: Much of the research to date on field triage decisions has been done in adults and has ignored the special needs of pediatric patients. To minimize under- and over- triage of injured children, data are needed to determine the accuracy of the Field Triage Decision Scheme and its components. Objectives:
Aim 1 : Describe the field findings of prehospital care providers caring for injured pediatric patients (age d15 years) and gather information on each patient's hospital resource use and clinical outcome.
Aim 2 : Retrospectively apply both the 1999 and 2006 Field Triage Decision Schemes to the data collected in Aim 1 and determine the rate of under- and over-triage for each scheme. Hypothesis, Aim 2: The 2006 Field Triage Decision Scheme will cause no more than a 1% increase in under-triage and will reduce over-triage by at least 10% compared to the 1999 scheme.
Aim 3 : Using the data collected in Aim 1 we will determine the predictive value of each component of the Field Triage Decision Scheme for identifying injured pediatric patients who need the resources of a pediatric trauma center. Hypothesis 1, Aim 3: The individual components of the Field Triage Decision Scheme are predictive of a composite measure of pediatric trauma center need (non-orthopedic surgery within 24 hours, intensive care unit admission, or death prior to hospital discharge). Hypothesis 2, Aim 3: The individual components of the Field Triage Decision Scheme are predictive of a patient Injury Severity Score >15. Study Design: A prospective, 19-month observational study is proposed. Setting: The study will be conducted at the children's hospitals in Milwaukee, WI;Rochester, NY;and Dallas, TX. Participants: All pediatric patients transported by emergency medical services to one of the three participating hospitals for an injury, regardless of severity, will be included. Interventions: The prehospital care providers in charge of each patient's care will complete an interview on what, if any, Field Triage Decision Scheme criteria the patient met. The patient will then be followed until discharge, and their treatments and outcome recorded. These data will be used to analyze the field triage criteria to determine which accurately identify patients who need the resources of a pediatric trauma center. Outcome Measures: Two definitions will be used to define need for a pediatric trauma center: (1) a composite measure of whether or not the patient had urgent non-orthopedic surgery, admission to an intensive care unit, and/or death and (2) an Injury Severity Score >15.
This proposed study will evaluate the accuracy of the Field Triage Decision Scheme to assist prehospital care providers in selecting the most appropriate destination hospital for injured pediatric patients. Much of the research to date on triage decisions after traumatic injuries has been done in adults and has ignored the special needs of children. Inappropriate selection of a destination could increase morbidity and mortality for injured children, subject them unnecessarily to the risks of transport by helicopter or by ambulance with lights and sirens, or cause the trauma system to be inefficient for other patients.
|Lerner, E Brooke; Cushman, Jeremy T; Drendel, Amy L et al. (2017) Effect of the 2011 Revisions to the Field Triage Guidelines on Under- and Over-Triage Rates for Pediatric Trauma Patients. Prehosp Emerg Care 21:456-460|
|Lerner, E Brooke; Drendel, Amy L; Cushman, Jeremy T et al. (2017) Ability of the Physiologic Criteria of the Field Triage Guidelines to Identify Children Who Need the Resources of a Trauma Center. Prehosp Emerg Care 21:180-184|