The accuracy of existing prehospital triage tools for injured children in England--an analysis using trauma registry data

Abstract

Objectives: To investigate the performance characteristics of prehospital paediatric triage tools for identifying seriously injured children in England.

Design: Eight prehospital paediatric triage tools were identified by literature review and by survey of the Lead Trauma Clinicians across English Strategic Health Authorities. Retrospective clinical registry data from the Trauma Audit and Research Network were used to determine the performance characteristics of each tool, using 'gold standards' for under- and over-triage of <5% and <25-50%, respectively, as benchmarks for performance.

Participants: 701 patient records were included. Inclusion criteria were all injured patients aged <16 years admitted to a receiving unit direct from the scene of accident in the period 2007-2010, for whom all key discriminator fields were recorded in the Trauma Audit and Research Network database.

Outcome measures: The main outcome measure was how each tool functioned with regard to their under- and over-triaging features. Other performance characteristics, for example, predictive values and likelihood ratios were also calculated.

Results: Two (of eight) triage tools demonstrated acceptable under-triage rates (3% and 4%) but had unacceptably high over-triage rates (83% and 72%). Two tools demonstrated acceptable over-triage rates (7% and 16%), but with unacceptably high under-triage rates (61% and 63%). Four tools had unacceptably high under- and over-triage rates.

Conclusions: None of the prehospital triage tools currently used or being developed in England meet recommended criteria for over- and under-triage rates. There is an urgent need for the development of triage tools to accurately risk-stratify injured children in the prehospital setting.

Keywords: Trauma; clinical; clinical care; clinical management; effectiveness; emergency care systems; emergency department; epidemiology; major incidents; major trauma management; paediatric emergency med; paediatric emergency medicine; paediatric injury; paediatric resuscitation; paediatrics; paramedics; resuscitation; statistics.