Prospective validation of an out-of-hospital decision rule to identify seriously injured children involved in motor vehicle crashes.
OBJECTIVE
To prospectively validate a previously published out-of-hospital clinical decision rule to identify seriously injured children involved in motor vehicle crashes (MVCs).


METHODS
The authors selected 20 Los Angeles County Fire Department fire stations, based on pediatric MVC call volume and geographic diversity, and 21 associated hospitals for participation in the study. Immediately following an MVC call involving a pediatric patient aged 0-14 years, each engine/paramedic squad completed a data form (15 variables, including vital signs, Glasgow Coma Scale score, and vehicular and crash characteristics). This study was conducted over a 24-month period. Outcomes included: 1) "serious injury" as defined by an Injury Severity Score (ISS) > or = 16 (primary outcome), and 2) need for specialized trauma care (emergent intubation, major nonorthopedic operative intervention or death in the first 24 hours, or pediatric intensive care unit stay longer than 48 hours), as assessed by retrospective chart review. Accuracy measures and binominal confidence intervals (CIs) were calculated for the decision rule validation.


RESULTS
One hundred seventy-five children were prospectively enrolled in the study; 36 children were excluded due to lack of hospital participation or missing hospital charts. There were four children with ISS > or = 16 (3%) and six children requiring specialized trauma care (4%). The sensitivities and specificities of the rule were: 100% (95% CI = 40% to 100%) and 73% (95% CI = 65% to 81%) for serious injury, and 83% (95% CI = 36% to 100%) and 74% (95% CI = 65% to 81%) for specialized trauma care, respectively.


CONCLUSIONS
Although definitive conclusions are limited by the sample size, the decision rule identified all seriously injured children involved in MVCs and had moderate specificity. The decision rule was less sensitive for identifying children requiring specialized trauma care. Larger validation studies are needed to adequately assess the utility of this rule before implementation.
Newgard
Craig D
CD
Center for Policy and Research in Emergency Medicine, Department of Emergency Medicine, Oregon Health & Science University, 3181 SW Sam Jackson Park Road, Mail Code CR-114, Portland, OR 97239-3098, USA. newgardc@ohsu.edu
Hui
Sai-Hung Joshua
SH
Griffin
Andrew
A
Wuerstle
Melanie
M
Pratt
Franklin
F
Lewis
Roger J
RJ
D000063:Accidents, Traffic; D000293:Adolescent; D001291:Attitude of Health Personnel; D002648:Child; D002675:Child, Preschool; D003661:Decision Support Techniques; D004632:Emergency Medical Services / Q000592:standards*; D005260:Female; D015600:Glasgow Coma Scale; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D015601:Injury Severity Score; D015141:Los Angeles; D008297:Male; D011446:Prospective Studies; D012680:Sensitivity and Specificity; D014187:Transportation of Patients; D014218:Triage / Q000592:standards*; D014947:Wounds and Injuries / Q000145:classification* / Q000209:etiology