title: Ability of the Physiologic Criteria of the Field Triage Guidelines to Identify Children Who Need the Resources of a Trauma Center.
abstract: There is limited research on how well the American College of Surgeons/Center for Disease Control and Prevention Guidelines for Field Triage of Injured Patients assist EMS providers in identifying children who need the resources of a trauma center.
  
  
  
  To determine the accuracy of the Physiologic Criteria (Step 1) of the Field Triage Guidelines in identifying injured children who need the resources of a trauma center.
  
  
  
  EMS providers who transported injured children 15 years and younger to pediatric trauma centers in 3 mid-sized cities were interviewed regarding patient demographics and the presence or absence of each of the Field Triage Guidelines criteria. Children were considered to have needed a trauma center if they had non-orthopedic surgery within 24 hours, ICU admission, or died. This data was obtained through a structured hospital record review. The over- and under-triage rates and positive likelihood ratios (+LR) were calculated for the overall Physiologic Criteria and each individual criterion.
  
  
  
  Interviews were conducted for 5,610 pediatric patients; outcome data were available for 5,594 (99.7%): 5% of all patients needed the resources of a trauma center and 19% met the physiologic criteria. Using the physiologic criteria alone, 51% of children who needed a trauma center would have been under-triaged and 18% would have been over-triaged (+LR 2.8, 95% CI 2.4-3.2). Glasgow Coma Score (GCS) < 14 had a +LR of 14.3 (95% CI 11.2-18.3), with EMS not obtaining a GCS in 4% of cases. 54% of those with an EMS GCS < 14 had an initial ED GCS < 14. Abnormal respiratory rate (RR) had a +LR of 2.2 (95% CI 1.8-2.6), with EMS not obtaining a RR in 5% of cases. 41% of those with an abnormal EMS RR had an abnormal initial ED RR. Systolic blood pressure (SBP) < 90 had a +LR of 3.5 (95% CI 2.5-5.1), with EMS not obtaining a SBP in 20% of cases. SBP was not obtained for 79% of children <1 year, 46% 1-4 years, 7% 5-9 years, and 2% 10-15 years. A total of 19% of those with an EMS SBP < 90 had an initial ED SBP < 90.
  
  
  
  The Physiologic Criteria are a moderate predictor of trauma center need for children. Missing or inaccurate vital signs may be limiting the predictive value of the Physiologic Criteria.
authors.forename: E Brooke
authors.initials: EB
authors.lastname: Lerner
authors.forename: Amy L
authors.initials: AL
authors.lastname: Drendel
authors.forename: Jeremy T
authors.initials: JT
authors.lastname: Cushman
authors.forename: Mohamed
authors.initials: M
authors.lastname: Badawy
authors.forename: Manish N
authors.initials: MN
authors.lastname: Shah
authors.forename: Clare E
authors.initials: CE
authors.lastname: Guse
authors.forename: Arthur
authors.initials: A
authors.lastname: Cooper
mesh_terms: D001794:Blood Pressure; D002648:Child; D002675:Child, Preschool; D004632:Emergency Medical Services / Q000592:standards; D005260:Female; D015600:Glasgow Coma Scale; D006301:Health Services Needs and Demand; D006801:Humans; D008297:Male; D020380:Needs Assessment / Q000592:standards*; D056152:Respiratory Rate; D012189:Retrospective Studies; D014193:Trauma Centers; D015599:Trauma Severity Indices; D014218:Triage / Q000379:methods / Q000592:standards*; D014947:Wounds and Injuries / Q000175:diagnosis / Q000503:physiopathology / Q000628:therapy*
keywords: emergency medical services; emergency medical technicians; pediatrics; triage; wounds and injury