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Pediatric scene triage: Appropriateness of trauma center referral
WED 0815
POOR RELIABILITY OF THE PEDIATRIC RISK OF MORTALITY (PRISM) SCORE IN TRIAGE OF INTER-HOSPITAL TRANSPORT Richard Orr. Shekhar Venkataraman. Carol Singleton. Dept. of Anesth/CCM and Peds. Univ. of Pgh .• Children's Hospital of Pgh., 3705 Fifth Ave. Pgh., PA 15213 introduction: Children requiring transport (PT) to a tertiary care center may require major interventions during PT reflecting their severity of illness, and may also require admission to the intensive care unit (ICU) though they have a low risk of mortality (ROM). Methods: We studied all patients (pts) transported to our hospital by our transport team (TT) between Oct-Dec '87 to test whether PRISM, an ROM index, can reliably identify pts who need ICU. PRISM was scored at initial phone (PH) contact and upon arrival of TT at the referring hospital. PT outcome was defined as admission location in our hospital (ICU or non-ICU). PH PRISM and 8-hour Therapeutic Intervention Score (TISS) of pts admitted to each location were compared. Results: 156 pts were studied. 77 went to ICU and 79 to non-ICU areas. 145/156 pts had a predicted ROM of ~5% based on PH PRISM and age. 69/77 ICU pts had a predicted ROM ~5%. Of these 69 pts, 42 (61%) were intubated, 14 (20%) needed inotropes, 13 (19%) needed drugs for active seizures, and 8 (12%) needed >20cc/kg fluids for hypotension. The sensitivity of a PH PRISM score> 1 in correctly classifying pts going to ICU was only 64%, decreasing to 13% for a score >10. In fact, 25/84 (30%) pts with a PH PRISM of 0 required leu. ICU pts had higher TISS scores (20.6±14.S vs 3.9±3.7, ICU vs non-ICU, p<.OOl). TISS for pts with a predicted ROM ~5% was also higher for ICU pts (19.8±14.8 vs 3.8±3.6, ICU vs non-ICU, p<.OOI). Conclusion: 93% of pts transported had a predicted ROM of ~5%, and 48% with a predicted ROM of ~5% required ICU. Pts admitted to ICU required a higher level of care during PT. A particular PH PRISM score did not reliably identify pts requiring major interventions during PT who were subsequently admitted to ICU. ROM indices should not be used for triage of PT. 54
WED 0830 PEDIATRIC SCENE TRIAGE: APPROPRIATENESS OF TRAUMA CENTER REFERRAL Linda Manley. Susan Robins. Robert Falcone, Life Flight. Grant Medical Center, I I I S. Grant Ave .• Columbus, Ohio 43215 Introduction The ability of a non-physic ian to make triage decis ions in children based on simple field criteria (prolonged loss of consciousness. shock, respiratory distress, penetrating injury tc a body cavity, multiple in juries. o r evidence of high impact) remains in question, stimulating this study. Methods The char ts of 99 children transported from the scene of accident by helicopter from 1986 through 1988 were reviewed. Pediatric Trauma Score (PTS) , Modified Infant Coma Score (MICS), a n d Modified Injury Severity Score (MISS) were calculated r etrospectively. Trauma Center triage was considered appropriate i f ACS Triage gUidelines were ful filled. Statistical analysis: student's t t est, s ignificance at p<0.05. Results 99 children averaged 7.2 years old (range 1-14). Mechanisms of injury included 61 motor vehicle accidents, 10 falls, 9 drownings, 4 burns, 14 misc. in juries, and 2 penetrating injuries. Time from injury to Trauma Center averag ed 75.2 minutes; distance averaged 35.2 miles. Patients averaged a PTS of 6.9, MICS of 11.0 and MISS of 17.8. 7 patients d id not meet ACS triage criteria. Those inappropriately triaged or triaged solely on the basis of mechanism of injury (MECH) or age, had less severe injury than those triaged for physiologic reasons (PHYS): PHYS MECH AGE None N 49 38 5 7 HICS 7.2 14.7 14.8 15.0 PTS 4.5 8.8 9.6 11.1 MISS 20.5 8.0 1.2 6.7 Conclusions These data suggest prehospital personnel do not over t riage injured children for Trauma Center admission, by ACS standards; however, triage based solely on mechanism of inj~ry or age may not be appropriate in the chlld.
The Journal of Air Medical Transoort
>
October 1989
POOR RELIABILITY OF THE PEDIATRIC RISK OF MORTALITY (PRISM) SCORE IN TRIAGE OF INTER-HOSPITAL TRANSPORT Richard Orr. Shekhar Venkataraman. Carol Singleton. Dept. of Anesth/CCM and Peds. Univ. of Pgh .• Children's Hospital of Pgh., 3705 Fifth Ave. Pgh., PA 15213 introduction: Children requiring transport (PT) to a tertiary care center may require major interventions during PT reflecting their severity of illness, and may also require admission to the intensive care unit (ICU) though they have a low risk of mortality (ROM). Methods: We studied all patients (pts) transported to our hospital by our transport team (TT) between Oct-Dec '87 to test whether PRISM, an ROM index, can reliably identify pts who need ICU. PRISM was scored at initial phone (PH) contact and upon arrival of TT at the referring hospital. PT outcome was defined as admission location in our hospital (ICU or non-ICU). PH PRISM and 8-hour Therapeutic Intervention Score (TISS) of pts admitted to each location were compared. Results: 156 pts were studied. 77 went to ICU and 79 to non-ICU areas. 145/156 pts had a predicted ROM of ~5% based on PH PRISM and age. 69/77 ICU pts had a predicted ROM ~5%. Of these 69 pts, 42 (61%) were intubated, 14 (20%) needed inotropes, 13 (19%) needed drugs for active seizures, and 8 (12%) needed >20cc/kg fluids for hypotension. The sensitivity of a PH PRISM score> 1 in correctly classifying pts going to ICU was only 64%, decreasing to 13% for a score >10. In fact, 25/84 (30%) pts with a PH PRISM of 0 required leu. ICU pts had higher TISS scores (20.6±14.S vs 3.9±3.7, ICU vs non-ICU, p<.OOl). TISS for pts with a predicted ROM ~5% was also higher for ICU pts (19.8±14.8 vs 3.8±3.6, ICU vs non-ICU, p<.OOI). Conclusion: 93% of pts transported had a predicted ROM of ~5%, and 48% with a predicted ROM of ~5% required ICU. Pts admitted to ICU required a higher level of care during PT. A particular PH PRISM score did not reliably identify pts requiring major interventions during PT who were subsequently admitted to ICU. ROM indices should not be used for triage of PT. 54
WED 0830 PEDIATRIC SCENE TRIAGE: APPROPRIATENESS OF TRAUMA CENTER REFERRAL Linda Manley. Susan Robins. Robert Falcone, Life Flight. Grant Medical Center, I I I S. Grant Ave .• Columbus, Ohio 43215 Introduction The ability of a non-physic ian to make triage decis ions in children based on simple field criteria (prolonged loss of consciousness. shock, respiratory distress, penetrating injury tc a body cavity, multiple in juries. o r evidence of high impact) remains in question, stimulating this study. Methods The char ts of 99 children transported from the scene of accident by helicopter from 1986 through 1988 were reviewed. Pediatric Trauma Score (PTS) , Modified Infant Coma Score (MICS), a n d Modified Injury Severity Score (MISS) were calculated r etrospectively. Trauma Center triage was considered appropriate i f ACS Triage gUidelines were ful filled. Statistical analysis: student's t t est, s ignificance at p<0.05. Results 99 children averaged 7.2 years old (range 1-14). Mechanisms of injury included 61 motor vehicle accidents, 10 falls, 9 drownings, 4 burns, 14 misc. in juries, and 2 penetrating injuries. Time from injury to Trauma Center averag ed 75.2 minutes; distance averaged 35.2 miles. Patients averaged a PTS of 6.9, MICS of 11.0 and MISS of 17.8. 7 patients d id not meet ACS triage criteria. Those inappropriately triaged or triaged solely on the basis of mechanism of injury (MECH) or age, had less severe injury than those triaged for physiologic reasons (PHYS): PHYS MECH AGE None N 49 38 5 7 HICS 7.2 14.7 14.8 15.0 PTS 4.5 8.8 9.6 11.1 MISS 20.5 8.0 1.2 6.7 Conclusions These data suggest prehospital personnel do not over t riage injured children for Trauma Center admission, by ACS standards; however, triage based solely on mechanism of inj~ry or age may not be appropriate in the chlld.
The Journal of Air Medical Transoort
>
October 1989