Validation of the Pediatric Physiological and Anatomical Triage Score in Injured Pediatric Patients

2019 ◽  
Vol 34 (04) ◽  
pp. 363-369
Author(s):  
Takashi Muguruma ◽  
Chiaki Toida ◽  
Shintaro Furugori ◽  
Takeru Abe ◽  
Ichiro Takeuchi
Keyword(s):  
Pediatric Patients ◽  
Injury Severity ◽  
Vital Signs ◽  
Data Bank ◽  
Medical Treatments ◽  
Priority Ranking ◽  
Life Saving ◽  
Revised Trauma Score ◽  
Trauma Score ◽  
Japan Trauma Data Bank

AbstractIntroduction:Triaging plays an important role in providing suitable care to a large number of casualties in a disaster setting. A Pediatric Physiological and Anatomical Triage Score (PPATS) was developed as a new secondary triage method. This study aimed to validate the accuracy of the PPATS in identifying injured pediatric patients who are admitted at a high frequency and require immediate treatment in a disaster setting. The PPATS method was also compared with the current triage methods, such as the Triage Revised Trauma Score (TRTS).Methods:A retrospective review of pediatric patients aged ≤15 years, registered in the Japan Trauma Data Bank (JTDB) from 2012 through 2016, was conducted and PPATS was performed. The PPATS method graded patients from zero to 22, and was calculated based on vital signs, anatomical abnormalities, and the need for life-saving interventions. It categorized patients based on their priority, and the intensive care unit (ICU)-indicated patients were assigned a PPATS ≥six. The accuracy of PPATS and TRTS in predicting the outcome of ICU-indicated patients was compared.Results:Of 2,005 pediatric patients, 1,002 (50%) were admitted to the ICU. The median age of the patients was nine years (interquartile range [IQR]: 6-13 years). The sensitivity and specificity of PPATS were 78.6% and 43.7%, respectively. The area under the receiver-operating characteristic (ROC) curve (AUC) was larger for PPATS (0.61; 95% confidence interval [CI], 0.59-0.63) than for TRTS (0.57; 95% CI, 0.56-0.59; P <.01). Regression analysis showed a significant correlation between PPATS and the Injury Severity Score (ISS; r2 = 0.353; P <.001), predicted survival rate (r2 = 0.396; P <.001), and duration of hospital stay (r2 = 0.252; P <.001).Conclusion:The accuracy of PPATS for injured pediatric patients was superior to that of current secondary triage methods. The PPATS method is useful not only for identifying high-priority patients, but also for determining the priority ranking for medical treatments and evacuation.

scholarly journals Validation of the Pediatric Physiological and Anatomical Triage Score in Pediatric Patients with Burn Injuries

2019 ◽  
Vol 34 (s1) ◽  
pp. s61-s61 ◽  
Author(s):  
Chiaki Toida ◽  
Takashi Muguruma ◽  
Ichiro Takeuchi ◽  
Naoto Morimura
Keyword(s):  
Pediatric Patients ◽  
Injury Severity ◽  
Characteristic Curve ◽  
Vital Signs ◽  
Burn Injuries ◽  
Priority Ranking ◽  
Life Saving ◽  
Revised Trauma Score ◽  
Trauma Score ◽  
Accuracy Of Prediction

Introduction:Triaging plays an important role in providing suitable care to the largest number of casualties in a disaster setting. We developed the Pediatric Physiological and Anatomical Triage score (PPATS) as a new secondary triage method.Aim:This study was performed to validate the accuracy of the PPATS in pediatric patients with burn injuries.Methods:A retrospective review of pediatric patients with burn injuries younger than 15 years old registered in the Japan Trauma Databank from 2004 to 2016 was conducted. The PPATS, which was assigned scores from 0 to 22, was calculated based on vital signs, anatomical abnormalities, and need for life-saving intervention. The PPATS categorized the patients by their priority and defined the intensive care unit (ICU)-indicated patients as those with PPARSs more than 6. This study compared the accuracy of prediction of ICU-indicated patients between the PPATS and Triage Revised Trauma Score (TRTS).Results:Among 87 pediatric patients, 62 (71%) were admitted to the ICU. The median age was 3 years (interquartile range: 1 to 9 years old). The sensitivity and specificity of the PPATS were 74% and 36%, respectively. The area under the receiver-operating characteristic curve was not different between the PPTAS [0.51 (95% confidence interval: -0.51–1.48) and the TRTS [0.51 (-1.17–1.62), p=0.57]. Regression analysis showed a significant association between the PPATS and the Injury Severity Score (ISS) (r2=0.39, p<0.01). On the other hand, there is no association between the TRTS and the ISS (r2=0.00, p=0.79).Discussion:The accuracy of the PPATS was not superior to that of current secondary-triage methods. However, the PPATS had the advantage of objectively determining the triage priority ranking based on the severity of the pediatric patients with burn injuries.

Perineal Injuries at a Large Urban Trauma Center: Injury Patterns and Outcomes

2009 ◽  
Vol 75 (4) ◽  
pp. 317-320 ◽  
Author(s):  
Patrizio Petrone ◽  
Kenji Inaba ◽  
Nir Wasserberg ◽  
Pedro G. R. Teixeira ◽  
Grant Sarkisyan ◽  
...  
Keyword(s):  
Los Angeles ◽  
Injury Severity ◽  
Medical Center ◽  
Vital Signs ◽  
University Of Southern California ◽  
Associated Injuries ◽  
Survival Group ◽  
Revised Trauma Score ◽  
Perineal Injuries ◽  
Trauma Score

The purpose of this study was to describe the characteristics of this unique patient population, their clinical presentations, and outcomes. The Los Angeles County and University of Southern California Medical Center Trauma Registry was used to retrospectively identify patients who sustained perineal injuries. Information included gender, age, vital signs, trauma scores, mechanisms of injury, studies performed, surgeries performed, and outcomes. Pediatric patients and injuries related to obstetric trauma were not included. Sixty-nine patients were identified between February 1, 1992 and October 31, 2005. One patient died on arrival; 85 per cent (58 of 68) were males, mean age was 30 ± 12 years, and there was a penetrating mechanism in 56 per cent. Vital signs on admission were systolic blood pressure 119 ± 33 mmHg, heart rate 94 ± 27 beats/minute, and respiratory rate 20 ± 6 breaths/min. Glasgow Coma Scale (GCS) was 13 ± 3, Revised Trauma Score (RTS) was 7.2 ± 1.5, and Injury Severity Score (ISS) was 11 ± 12. CT scan was obtained for 23 (33%) patients. Lower extremity fractures were 35 per cent and pelvic fractures 32 per cent. The most common surgery was debridement and drainage, diversion with colostomy in five patients (7%). Overall mortality was 10 per cent. Mortality group mean scores were: GCS, 6; RTS, 5.74; and ISS, 34. The survival group mean scores were: GCS, 14; RTS, 7.7; and ISS, 8. There was a statistically significant association between mortality and GCS, RTS, and ISS scores ( P < 0.001). Most patients with perineal injuries (93%) can be managed without colostomy. Associated injuries are not uncommon, particularly bony fractures. Mortality is mostly the result of exsanguination related to associated injuries.

Assessment of Blood Consumption score for pediatrics (ped-ABC score) predicts transfusion requirements for children with trauma.

2020 ◽  
Author(s):  
Akira Komori ◽  
Gautam A. Deshpande ◽  
Makoto Aoki ◽  
Daizoh Saitoh ◽  
Toshio Naito ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Heart Rate ◽  
Systolic Blood Pressure ◽  
Vital Signs ◽  
Data Bank ◽  
C Statistic ◽  
Disturbance Of Consciousness ◽  
Life Saving ◽  
Transfusion Requirements ◽  
Japan Trauma Data Bank

Abstract Background Although transfusion is one of primary life-saving elements, the assessment of requirement for transfusion in children with trauma at an early phase has been challenging. We aimed to develop a scoring system for predicting transfusion requirements in children with trauma. Methods This is a retrospective cohort study, which employed a nationwide registry of patients with trauma (Japan Trauma Data Bank) and included the patients aged < 16 years with blunt trauma between 2004 and 2015. An Assessment of Blood Consumption score for pediatrics (ped-ABC score) was developed based on previous literatures and clinical relevance. One point was assigned for each of the following criteria: systolic blood pressure ≤ 90 mmHg; heart rate ≥ 120/min; Glasgow Coma Scale (GCS) < 15; and positive result on focused assessment with sonography for trauma (FAST) scan. For sensitivity analysis, we assessed age-adjusted ped-ABC scores using cut-off points for different ages. Results In total, 540 patients had transfusion within 24 hours after trauma among the eligible 5,943 pediatric patients with trauma. The in-hospital mortality rate was 2.6% (145/5,615). Transfusion increased from 7.6% (430/5,631) to 35.3% (110/312) in patients with systolic blood pressure ≤ 90 mmHg (1 point); from 6.1% (276/4,504) to 18.3% (264/1,439) for heart rate ≥ 120/min (1 point); from 4.1% (130/3,198) to 14.9% (410/2,745) for disturbance of consciousness with GCS < 15 (1 point); and from 7.4% (400/5,380) to 24.9% (140/563) for FAST positivity (1 point). The ped-ABC score of 0, 1, 2, 3, and 4 points were associated with the transfusion rates of 2.2% (48/2,210), 7.5% (198/2,628), 19.8% (181/912), 53.3% (88/165), and 89.3% (25/28), respectively. After age adjustment, c-statistic was 0.76 (95% CI, 0.74–0.78). Conclusions The ped-ABC score using the vital signs and FAST may be helpful in predicting the transfusion requirements within 24 hours for children with trauma.

Maintaining Low Transfusion and Angioembolization Rates in the Age of Nonoperative Management of Pediatric Blunt Splenic Injury

2014 ◽  
Vol 80 (11) ◽  
pp. 1159-1163 ◽  
Author(s):  
Vincent P. Duron ◽  
Kristopher M. Day ◽  
Shaun A. Steigman ◽  
Jeremy T. Aidlen ◽  
Francois I. Luks
Keyword(s):  
Blood Transfusion ◽  
Injury Severity ◽  
Splenic Injury ◽  
Nonoperative Management ◽  
Vital Signs ◽  
Transfusion Rate ◽  
Blunt Splenic Injury ◽  
Pediatric Hospitals ◽  
Revised Trauma Score ◽  
Trauma Score

Nonoperative management of hemodynamically stable blunt splenic injury (BSI) is the gold standard in children. Recent studies from nonpediatric surgery-specialized trauma centers have demonstrated a rise in transfusion and angioembolization associated with decreased splenectomy rates. We investigate the rate of splenectomy and nonsurgical interventions (angioembolization, blood transfusion) for BSI in a pediatric surgery-specialized trauma center. We conducted a retrospective review of children (0 to 18 years) treated between September 2001 and September 2011 at a children's hospital. Analyzed data included presenting vital signs, nadir hemoglobin, splenic injury grade, Revised Trauma Score, and Injury Severity Score (ISS). Measured outcomes included transfusion, angioembolization, and splenectomy rates. The study period was divided into three time periods to identify possible trends and compared with national averages. There were 180 patients, 91 with multiple injuries (50.6%) and 89 (49.4%) with isolated BSI. Seventy-six per cent of patients were male, average age was 12.8 years, and average ISS was 14.7. The overall splenectomy rate was 1.7 per cent (1.1% for isolated splenic injury). Our angioembolization rate was 0.6 per cent compared with 7.4 to 16 per cent nationally. Our transfusion rate was 14.4 per cent overall and 5.6 per cent for isolated splenic injury compared with 9.5 to 24.9 per cent nationally. Intervention rates remained unchanged over the study period. Splenectomy rates have remained low at our institution without an increase in angioembolization or transfusion. Children with splenic injuries treated at dedicated pediatric hospitals can be successfully managed nonoperatively without angioembolization or blood transfusion.

scholarly journals Desempenho dos ajustes do Trauma and Injury Severity Score (TRISS): revisão integrativa

2015 ◽  
Vol 49 (spe) ◽  
pp. 138-146 ◽  
Author(s):  
Cristiane de Alencar Domingues ◽  
Lilia de Souza Nogueira ◽  
Cristina Helena Costanti Settervall ◽  
Regina Marcia Cardoso de Sousa
Keyword(s):  
Injury Severity Score ◽  
Severity Score ◽  
Injury Severity ◽  
Revised Trauma Score ◽  
Trauma Score ◽  
Trauma And Injury

RESUMO Objetivo identificar estudos que realizaram ajustes na equação do Trauma and InjurySeverity Score (TRISS) e compararam a capacidade discriminatória da equação modificada com a original. Método Revisão integrativa de pesquisas publicadas entre 1990 e 2014 nas bases de dados LILACS, MEDLINE, PubMed e SciELO utilizando-se a palavra TRISS. Resultados foram incluídos 32 estudos na revisão. Dos 67 ajustes de equações do TRISS identificados, 35 (52,2%) resultaram em melhora na acurácia do índice para predizer a probabilidade de sobrevida de vítimas de trauma. Ajustes dos coeficientes do TRISS à população de estudo foram frequentes, mas nem sempre melhoraram a capacidade preditiva dos modelos analisados. A substituição de variáveis fisiológicas do Revised Trauma Score (RTS) e modificações do Injury Severity Score (ISS) na equação original tiveram desempenho variado. A mudança na forma de inclusão da idade na equação, assim como a inserção do gênero, comorbidades e mecanismo do trauma apresentaram tendência de melhora do desempenho do TRISS. Conclusão Diferentes propostas de ajustes no TRISS foram identificadas nesta revisão e indicaram, principalmente, fragilidades do RTS no modelo original e necessidade de alteração da forma de inclusão da idade na equação para melhora da capacidade preditiva do índice.

Pretrauma Functional Independence Measure Score Predicts Survival in Geriatric Trauma

2017 ◽  
Vol 83 (6) ◽  
pp. 559-563 ◽  
Author(s):  
Brian Fletcher ◽  
Eric Bradburn ◽  
Christopher Baker ◽  
Bryan Collier ◽  
Mark Hamill ◽  
...  
Keyword(s):  
Body Mass Index ◽  
Injury Severity Score ◽  
Trauma Patient ◽  
Severity Score ◽  
Injury Severity ◽  
Functional Independence Measure ◽  
Functional Independence ◽  
Geriatric Trauma ◽  
Revised Trauma Score ◽  
Trauma Score

The Functional Independence Measure (FIM) is used by rehabilitation professionals to access disability. The FIM score combines both motor and cognitive parameters to assess a patient's level of required assistance in performing activities of daily living (ADL). The geriatric trauma patient is becoming an increasingly important cohort for trauma services. FIM has been shown to predict discharge outcomes and those at high risk for falls. We hypothesized pretrauma FIM scores may predict survival in the geriatric trauma population. This was a retrospective study of patients 65 years and older that were admitted to our Level I trauma center from July 1, 2006 to July 1, 2012. A total 941 patients underwent stepwise regression to identify those factors predicting survival. Age, Injury Severity Score, revised trauma score, body mass index, and pretrauma FIM scores (12-point scale) were studied. The primary outcome was survival. Statistical significance reached at P value <0.05. Multiple logistic regression analysis was then performed. A total of 1315 patients were identified and complete data were available on 941 patients. Mean age was 78 (SD ± 8.2), mean Injury Severity Score was 13(SD ± 8.7), and mean body mass index was 26. Overall mortality was 11 per cent. The odds ratio of survival was 3.532 (95% confidence interval = 2.191–5.718) times greater for every 1-point increase in the preadmission FIM expression score. Glasgow Coma Scale, revised trauma score, gender, and pretrauma FIM expression scores were predictive of survival in the geriatric trauma patient. Pretrauma FIM expression can be used to predict survival in the elderly trauma victim. Further study is needed to establish the role of FIM as part of trauma scoring systems.

Car Surfing: Case Studies of a Growing Dangerous Phenomenon

2008 ◽  
Vol 74 (3) ◽  
pp. 260-261
Author(s):  
Steven Clark ◽  
Alicia Mangram ◽  
Ernest Dunn
Keyword(s):  
Injury Severity Score ◽  
Severity Score ◽  
Injury Severity ◽  
Surgical Intervention ◽  
Ventilatory Support ◽  
Retrospective Chart Review ◽  
Severe Injuries ◽  
Revised Trauma Score ◽  
Urban Level ◽  
Trauma Score

Car surfing is a dangerous new pastime for American youth. Car surfing is an activity that is defined as standing (or lying) on a vehicle while it is being driven. This activity frequently results in severe injuries that often require significant surgical intervention. Despite its destructive nature, however, there are many Internet sites that encourage this behavior and view it as amusing. As a result, car surfing is becoming increasingly popular. We conducted a retrospective chart review of all patients injured as a result of car surfing over the last 4 years at our Urban Level II trauma center. Data collected included Injury Severity Score (ISS), Revised Trauma Score (RTS), age, gender, injury pattern, surgical intervention, and length of stay. Eight car surfers were identified. The average age was 17. The average Revised Trauma Score was 6.8 with an average Injury Severity Score of 16.9. Five patients were admitted to the intensive care unit. Four of these five patients needed to be intubated for ventilatory support. Five of the eight patients had significant intracranial injuries. Two patients had epidural hematomas that required evacuation. Two other patients had subdural hematomas that were treated nonoperatively, and one patient had a subarachnoid hemorrhage that was also treated nonoperatively. Four of the eight patients required surgical intervention. There were no deaths in this study. Car surfing leads to severe injuries that can result in significant morbidity. American youth have access to Internet sites that project this activity as an acceptable behavior. Five of our eight patients had a significant intra-cranial injury. Trauma surgeons need to be more aware of this injury phenomenon.

scholarly journals Blunt and Penetrating Liver Trauma have Similar Outcomes in the Modern Era

2020 ◽  
pp. 145749692092164
Author(s):  
A. A. Keizer ◽  
J. H. C. Arkenbosch ◽  
V. Y. Kong ◽  
R. Hoencamp ◽  
J. L. Bruce ◽  
...  
Keyword(s):  
Standard Deviation ◽  
Injury Severity ◽  
Mortality Rates ◽  
Liver Trauma ◽  
Interquartile Range ◽  
Shock Index ◽  
Hepatic Trauma ◽  
Revised Trauma Score ◽  
The Mean ◽  
Trauma Score

Background: The trend in liver trauma management has progressively become increasingly conservative. However, a vast majority of literature focuses heavily on the management of blunt trauma. This study reviews the management of hepatic trauma at a major trauma center in a developing world setting, in order to compare blunt and penetrating liver trauma and to define current management algorithms and protocols. Methods: All patients who sustained liver trauma between 2012 to 2018 were identified in the Hybrid Electronic Medical Registry and extracted for further analysis. Results: A total of 808 patients with hepatic trauma were managed by our trauma center. There were 658 males and 150 females. The mean age was 30 years (standard deviation 13.3). A total of 68 patients died (8.2%) and a total of 290 (35%) patients required intensive care unit admission. The mean presenting shock index was 0.806 (standard deviation 0.67–1.0), the median Injury Severity Score was 18 (interquartile range 10–25) and the mean Revised Trauma Score was 12 (standard deviation 11–12). There were 367 penetrating and 441 blunt liver injuries. The age distribution was similar in both groups. There were significantly less females in the penetrating group. The shock index and the Injury Severity Score on presentation were significantly worse in the blunt group, respectively: 0.891 (standard deviation 0.31) versus 0.845 (standard deviation 0.69) (p < 0.001) and score 21 (interquartile range 13–27) versus 16 (interquartile range 9–20) (p < 0.01). The opposite applied to the Revised Trauma Score of 11.75 (standard deviation 0.74) versus 11.19 (standard deviation 1.3) (p < 0.001). There were significantly more associated intra-abdominal injuries in the penetrating group than the blunt group, in particular that of hollow organs, and 84% of patients with a penetrating injury underwent a laparotomy while only 33% of the blunt injuries underwent a laparotomy. The mortality rate was comparable between both groups. Conclusion: Hepatic trauma is still associated with a high morbidity rate, although there have been dramatic improvements in mortality rates over the last three decades. The mortality rates for blunt and penetrating liver trauma are now similar. Non-operative management is feasible for over two-thirds of blunt injuries and for just under 20% of penetrating injuries.

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