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. 2022 Oct 13;28(1):17-23.
doi: 10.1093/pch/pxac085. eCollection 2023 Feb.

Evaluation of activation criteria in paediatric multi-trauma

Neta Cohen  1 , Adrienne L Davis  1 , Gidon Test  1 , Dana Singer-Harel  1 , Yehonatan Pasternak  2 , Suzanne Beno  1 , Dennis Scolnik  1
Affiliations

Evaluation of activation criteria in paediatric multi-trauma

Neta Cohen et al. Paediatr Child Health. .

Abstract

Objective: To explore the optimal set of trauma activation criteria predicting paediatric patients' need for acute care following multi-trauma, with particular attention to Glasgow Coma Scale (GCS) cut-off value.

Methods: A retrospective cohort study of paediatric multi-trauma patients aged 0 to 16 years, performed at a Level 1 paediatric trauma centre. Trauma activation criteria and GCS levels were examined with respect to patients' need for acute care, defined as: direct to operating room disposition, intensive care unit admission, need for acute interventions in the trauma room, or in-hospital death.

Results: We enrolled 436 patients (median age 8.0 years). The following predicted need for acute care: GCS <14 (adjusted odds ratio [aOR] 23.0, 95% confidence interval [CI]: 11.5 to 45.9, P < 0.001), hemodynamic instability: (aOR 3.7, 95% CI: 1.2-8.1, P = 0.01), open pneumothorax/flail chest (aOR: 20.0, 95% CI: 4.0 to 98.7, P < 0.001), spinal cord injury (aOR 15.4, 95% CI; 2.4 to 97.1, P = 0.003), blood transfusion at the referring hospital (aOR: 7.7, 95% CI: 1.3 to 44.2, P = 0.02) and GSW to the chest, abdomen, neck, or proximal extremities (aOR 11.0, 95% CI; 1.7 to 70.8, P = 0.01). Using these activation criteria would have decreased over- triage by 10.7%, from 49.1% to 37.2% and under-triage by 1.3%, from 4.7% to 3.5%, in our cohort of patients.

Conclusions: Using GCS<14, hemodynamic instability, open pneumothorax/flail chest, spinal cord injury, blood transfusion at the referring hospital, and GSW to the chest, abdomen, neck of proximal extremities, as T1 activation criteria could decrease over- and under-triage rates. Prospective studies are needed to validate the optimal set of activation criteria in paediatric patients.

Keywords: Activation criteria; Acute care; Children; Glasgow Coma Scale; Multi-trauma.

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Figures

Figure 1.
Figure 1.
Trauma patients presenting to SickKids during the study.
Figure 2.
Figure 2.
ROC curve for GCS score versus patients’ need for acute care. The optimal GCS cut-off was a score of <14 yielding an area under the curve of 0.76. GCS Glasgow Coma Scale; ROC receiver operating curves.
See this image and copyright information in PMC

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