title: Validation of rules to predict emergent surgical intervention in pediatric trauma patients.
abstract: BACKGROUND
  Trauma centers use guidelines to determine when a trauma surgeon is needed in the emergency department (ED) on patient arrival. A decision rule from Loma Linda University identified patients with penetrating injury and tachycardia as requiring emergent surgical intervention. Our goal was to validate this rule and to compare it with the American College of Surgeons' Major Resuscitation Criteria (MRC).
  
  
  METHODS
  We used data from 1993 through 2010 from 2 level 1 trauma centers in Denver, CO. Patient demographics, injury severity, times of ED arrival and surgical intervention, and all variables of the Loma Linda Rule and the MRC were obtained. The outcome, emergent intervention (defined as requiring operative intervention by a trauma surgeon within 1 hour of arrival to the ED or performance of cricothyroidotomy or thoracotomy in the ED), was confirmed using standardized abstraction. Sensitivities, specificities, and 95% confidence intervals were calculated.
  
  
  RESULTS
  There were 8,078 patients included, and 47 (0.6%) required emergent intervention. Of the 47 patients, the median age was 11 years (interquartile range [IQR] 7 to 14 years), 70% were male, 30% had penetrating mechanisms, and the median Injury Severity Score (ISS) was 25 (IQR 9 to 41). At the 2 institutions, the Loma Linda Rule had a sensitivity and specificity of 69% (95% CI 45% to 94%) and 76% (95% CI 69% to 83%), respectively, and the MRC had a sensitivity and specificity of 80% (95% CI 70% to 92%) and 81% (95% CI 77% to 85%), respectively.
  
  
  CONCLUSIONS
  Emergent surgical intervention is rare in the pediatric trauma population. Although precision of predictive accuracies of the Loma Linda Rule and MRC were limited by small numbers of outcomes, neither set of criteria appears to be sufficiently accurate to recommend their routine use.
authors.affiliation: Department of Emergency Medicine, Denver Health Medical Center, Denver, CO 80204, USA.
authors.forename: Dowin H
authors.initials: DH
authors.lastname: Boatright
authors.forename: Richard L
authors.initials: RL
authors.lastname: Byyny
authors.forename: Emily
authors.initials: E
authors.lastname: Hopkins
authors.forename: Katherine
authors.initials: K
authors.lastname: Bakes
authors.forename: Jennifer
authors.initials: J
authors.lastname: Hissett
authors.forename: Java
authors.initials: J
authors.lastname: Tunson
authors.forename: Joshua S
authors.initials: JS
authors.lastname: Easter
authors.forename: Comilla
authors.initials: C
authors.lastname: Sasson
authors.forename: Jody A
authors.initials: JA
authors.lastname: Vogel
authors.forename: Denis
authors.initials: D
authors.lastname: Bensard
authors.forename: Jason S
authors.initials: JS
authors.lastname: Haukoos
mesh_terms: D000293:Adolescent; D002648:Child; D003120:Colorado; D003661:Decision Support Techniques; D005260:Female; D006801:Humans; D015601:Injury Severity Score; D008297:Male; D017410:Practice Guidelines as Topic / Q000592:standards*; D011237:Predictive Value of Tests; D011379:Prognosis; D012151:Resuscitation; D012680:Sensitivity and Specificity; D013908:Thoracotomy; D014140:Tracheotomy; D014193:Trauma Centers; D014218:Triage / Q000592:standards*; D014947:Wounds and Injuries / Q000175:diagnosis / Q000601:surgery*