title: Evaluation of developmental metrics for utilization in a pediatric advanced automatic crash notification algorithm.
abstract: OBJECTIVE
  Appropriate treatment at designated trauma centers (TCs) improves outcomes among injured children after motor vehicle crashes (MVCs). Advanced Automatic Crash Notification (AACN) has shown promise in improving triage to appropriate TCs. Pediatric-specific AACN algorithms have not yet been created. To create such an algorithm, it will be necessary to include some metric of development (age, height, or weight) as a covariate in the injury risk algorithm. This study sought to determine which marker of development should serve as a covariate in such an algorithm and to quantify injury risk at different levels of this metric.
  
  
  METHODS
  A retrospective review of occupants age < 19 years within the MVC data set NASS-CDS 2000-2011 was performed. R(2) values of logistic regression models using age, height, or weight to predict 18 key injury types were compared to determine which metric should be used as a covariate in a pediatric AACN algorithm. Clinical judgment, literature review, and chi-square analysis were used to create groupings of the chosen metric that would discriminate injury patterns. Adjusted odds of particular injury types at the different levels of this metric were calculated from logistic regression while controlling for gender, vehicle velocity change (delta V), belted status (optimal, suboptimal, or unrestrained), and crash mode (rollover, rear, frontal, near-side, or far-side).
  
  
  RESULTS
  NASS-CDS analysis produced 11,541 occupants age < 19 years with nonmissing data. Age, height, and weight were correlated with one another and with injury patterns. Age demonstrated the best predictive power in injury patterns and was categorized into bins of 0-4 years, 5-9 years, 10-14 years, and 15-18 years. Age was a significant predictor of all 18 injury types evaluated even when controlling for all other confounders and when controlling for age- and gender-specific body mass index (BMI) classifications. Adjusted odds of key injury types with respect to these age categorizations revealed that younger children were at increased odds of sustaining Abbreviated Injury Scale (AIS) 2+ and 3+ head injuries and AIS 3+ spinal injuries, whereas older children were at increased odds of sustaining thoracic fractures, AIS 3+ abdominal injuries, and AIS 2+ upper and lower extremity injuries.
  
  
  CONCLUSIONS
  The injury patterns observed across developmental metrics in this study mirror those previously described among children with blunt trauma. This study identifies age as the metric best suited for use in a pediatric AACN algorithm and utilizes 12 years of data to provide quantifiable risks of particular injuries at different levels of this metric. This risk quantification will have important predictive purposes in a pediatric-specific AACN algorithm.
authors.affiliation: a Wake Forest School of Medicine , Department of General Surgery , Winston-Salem , North Carolina.|b Wake Forest School of Medicine, Childress Institute for Pediatric Trauma , Winston-Salem , North Carolina.
authors.forename: Andrea N
authors.initials: AN
authors.lastname: Doud
authors.affiliation: c Wake Forest School of Medicine , Department of Biomedical Engineering , Winston-Salem , North Carolina.
authors.forename: Ashley A
authors.initials: AA
authors.lastname: Weaver
authors.affiliation: d Wake Forest School of Medicine, Division of Public Health Sciences , Winston-Salem , North Carolina.
authors.forename: Jennifer W
authors.initials: JW
authors.lastname: Talton
authors.affiliation: d Wake Forest School of Medicine, Division of Public Health Sciences , Winston-Salem , North Carolina.
authors.forename: Ryan T
authors.initials: RT
authors.lastname: Barnard
authors.affiliation: a Wake Forest School of Medicine , Department of General Surgery , Winston-Salem , North Carolina.|b Wake Forest School of Medicine, Childress Institute for Pediatric Trauma , Winston-Salem , North Carolina.
authors.forename: John
authors.initials: J
authors.lastname: Petty
authors.affiliation: b Wake Forest School of Medicine, Childress Institute for Pediatric Trauma , Winston-Salem , North Carolina.|c Wake Forest School of Medicine , Department of Biomedical Engineering , Winston-Salem , North Carolina.
authors.forename: Joel D
authors.initials: JD
authors.lastname: Stitzel
mesh_terms: D015998:Abbreviated Injury Scale; D000063:Accidents, Traffic / Q000706:statistics & numerical data*; D000293:Adolescent; D000465:Algorithms; D002648:Child; D002657:Child Development; D002675:Child, Preschool; D005260:Female; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D016015:Logistic Models; D008297:Male; D010372:Pediatrics / Q000379:methods*; D015203:Reproducibility of Results; D012189:Retrospective Studies; D018570:Risk Assessment; D014193:Trauma Centers; D014218:Triage / Q000379:methods*; D014481:United States; D014947:Wounds and Injuries / Q000209:etiology / Q000628:therapy*
keywords: AACN; childhood development; pediatric trauma