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Criteria for safe cost-effective pediatric trauma triage: Prehospital evaluation and distribution of injured children
The Journalof EmergencyMedicine,Vol 13,No 5, pp 731-738,1995 Copyright 0 1994Else&r ScienceLtd Printedin the USA. All rights resewed 0736-4679/9S $9.50+ .OO 073&4679(95)ooo74-7
DREN. Sola JE, Scherer LR, Haller JA Jr. et al. J Pediatr Surg. 1994;29:738-41. Trauma is the leading cause of death in children O-14 years of age, yet pediatric trauma triage has only recently been evaluated. This study proposed a two-tiered pediatric triage system which would help safely sort those victims requiring pediatric intensive care (PICU) or operative management. All pediatric trauma victims aged O-15 years were evaluated at a regional pediatric therapy center over 13 months, starting in January 1991. Triage was based on field information including vital signs, neurolugical status, mechanism of injury, and limited anatomic information. Two-hundred sixteen patients were assigned to the Alpha group (those likely to require operating room or PICU), and 736 were assigned to the Bravo group (those not likely to require either facility). The Alpha designation applied to those patients in shock or respiratory distress, Glascow coma score less than 9, serious mechanism of injury, or who had sustained specific potentially lethal injuries. The Bravo designation were patients who has a reported loss of consciousness or a significant mechanism of injury. Blunt trauma was the predominant mechanism of injury (95Vo). Overall mortality was 1.6%, with no deaths among Bravo patients. Nearly two-thirds of Alpha patients went to the operating room or PICU, while 97% of Bravo patients were admitted to the ward or discharged. Failure of the system to work in 23 casesgave the triage classification a sensitivity of 86% and a specificity of 90%. The authors concluded that further fine-tuning of a triage system can be useful in the function of a regional pediatric trauma center. [Susan Babes, MD] Editor’s Comment: There seems to be a considerable amount of overlap between these triage classifications. It is important to get appropriate patients to a trauma center with a pediatric commitment.
c] THE EFFECT OF LAPAROTOMY AND EXTERNAL FIXATOR STARiLIZATION ON PELVIC VOLUME IN AN UNSTABLE PELVIC INJURY. Ghanayem
AJ, Wilber JH, Lieberman JM, et al. J Trauma. 1995;38: 396-400.
This study used a cadaveric pelvic fracture model in an effort to determine if laparotomy further destabilized an unstable pelvic injury, and if reduction and stabilization of the fracture prevented volume changes secondary to laparotomy. The authors created unilateral open-book pelvic ring injuries in five fresh cadaveric specimens and determined pelvic volume by using computed axial tomography. Pehic volume was determined for the intact pelvis, the disrupted pelvis, pre- and post-laparotomy incision, and the disrupted pelvis stabilized and reduced via an external fixator with the laparotomy incision opened. It was found that the average pelvic volume increased 15 i 5% from a nonstabilized injury with the abdomen closed and to one subsequently opened. In addition, the average increase in entire pelvic volume was 26 f 5% between a stabilized and reduced pelvis and a nonstabilized pelvis, both with the abdomen open. The authors concluded from these results that the abdominal wall does provide support to an unstable pelvic ring injury, and that a single-pin external fixator can effectively prevent the destabilizing effect of laparotomy on these injuries, thereby preventing increased blood loss. Therefore, the authors recommend reduction and temporary stabilization of unstable pelvic injuries before or concomitantly with laparotomy. [Mark Prather, MD] Editor’s Comment:The application of a device such as an external fixator has become an important management strategy, and when an unstable fracture is identified, should be initiated early in the patient’s course. 0 CRlTElRJA FOR SAFE COST-EFFECTIVE PEDIATRIC TRAUMA TRIAGE: PRRHOSPITAL EVALUATION AND DBTRDKITION OF INJURED CHIL-
Cl A CONTROLLED TRIAL OF IWETHYWEDIVISOLONE IN THE EARLY EMERGENCY DEPARTMENT
Abstracts-is coordinated by Jedd Roe, MD, of Denver General Hospital, Denver, Colorado. Abstracts are prepared by the Emergency Medicine Residents of the University of Florida Health Science Center, Jacksonville, Florida; Denver Affiliated Residency in Emergency Medicine, Denver, Colorado: and the University of California-San Diego Medical Center, San Diego, California
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DREN. Sola JE, Scherer LR, Haller JA Jr. et al. J Pediatr Surg. 1994;29:738-41. Trauma is the leading cause of death in children O-14 years of age, yet pediatric trauma triage has only recently been evaluated. This study proposed a two-tiered pediatric triage system which would help safely sort those victims requiring pediatric intensive care (PICU) or operative management. All pediatric trauma victims aged O-15 years were evaluated at a regional pediatric therapy center over 13 months, starting in January 1991. Triage was based on field information including vital signs, neurolugical status, mechanism of injury, and limited anatomic information. Two-hundred sixteen patients were assigned to the Alpha group (those likely to require operating room or PICU), and 736 were assigned to the Bravo group (those not likely to require either facility). The Alpha designation applied to those patients in shock or respiratory distress, Glascow coma score less than 9, serious mechanism of injury, or who had sustained specific potentially lethal injuries. The Bravo designation were patients who has a reported loss of consciousness or a significant mechanism of injury. Blunt trauma was the predominant mechanism of injury (95Vo). Overall mortality was 1.6%, with no deaths among Bravo patients. Nearly two-thirds of Alpha patients went to the operating room or PICU, while 97% of Bravo patients were admitted to the ward or discharged. Failure of the system to work in 23 casesgave the triage classification a sensitivity of 86% and a specificity of 90%. The authors concluded that further fine-tuning of a triage system can be useful in the function of a regional pediatric trauma center. [Susan Babes, MD] Editor’s Comment: There seems to be a considerable amount of overlap between these triage classifications. It is important to get appropriate patients to a trauma center with a pediatric commitment.
c] THE EFFECT OF LAPAROTOMY AND EXTERNAL FIXATOR STARiLIZATION ON PELVIC VOLUME IN AN UNSTABLE PELVIC INJURY. Ghanayem
AJ, Wilber JH, Lieberman JM, et al. J Trauma. 1995;38: 396-400.
This study used a cadaveric pelvic fracture model in an effort to determine if laparotomy further destabilized an unstable pelvic injury, and if reduction and stabilization of the fracture prevented volume changes secondary to laparotomy. The authors created unilateral open-book pelvic ring injuries in five fresh cadaveric specimens and determined pelvic volume by using computed axial tomography. Pehic volume was determined for the intact pelvis, the disrupted pelvis, pre- and post-laparotomy incision, and the disrupted pelvis stabilized and reduced via an external fixator with the laparotomy incision opened. It was found that the average pelvic volume increased 15 i 5% from a nonstabilized injury with the abdomen closed and to one subsequently opened. In addition, the average increase in entire pelvic volume was 26 f 5% between a stabilized and reduced pelvis and a nonstabilized pelvis, both with the abdomen open. The authors concluded from these results that the abdominal wall does provide support to an unstable pelvic ring injury, and that a single-pin external fixator can effectively prevent the destabilizing effect of laparotomy on these injuries, thereby preventing increased blood loss. Therefore, the authors recommend reduction and temporary stabilization of unstable pelvic injuries before or concomitantly with laparotomy. [Mark Prather, MD] Editor’s Comment:The application of a device such as an external fixator has become an important management strategy, and when an unstable fracture is identified, should be initiated early in the patient’s course. 0 CRlTElRJA FOR SAFE COST-EFFECTIVE PEDIATRIC TRAUMA TRIAGE: PRRHOSPITAL EVALUATION AND DBTRDKITION OF INJURED CHIL-
Cl A CONTROLLED TRIAL OF IWETHYWEDIVISOLONE IN THE EARLY EMERGENCY DEPARTMENT
Abstracts-is coordinated by Jedd Roe, MD, of Denver General Hospital, Denver, Colorado. Abstracts are prepared by the Emergency Medicine Residents of the University of Florida Health Science Center, Jacksonville, Florida; Denver Affiliated Residency in Emergency Medicine, Denver, Colorado: and the University of California-San Diego Medical Center, San Diego, California
731