Skip to main content Accessibility help
×
Home
Hostname: page-component-564cf476b6-scc96 Total loading time: 5.364 Render date: 2021-06-22T21:58:33.482Z Has data issue: true Feature Flags: { "shouldUseShareProductTool": true, "shouldUseHypothesis": true, "isUnsiloEnabled": true, "metricsAbstractViews": false, "figures": true, "newCiteModal": false, "newCitedByModal": true, "newEcommerce": true }

Validation of the Pediatric Physiological and Anatomical Triage Score in Injured Pediatric Patients

Published online by Cambridge University Press:  25 July 2019

Takashi Muguruma
Affiliation:
Department of Emergency Medicine, Yokohama City University Graduate School of Medicine, Yokohama, Japan
Chiaki Toida
Affiliation:
Department of Emergency Medicine, Yokohama City University Graduate School of Medicine, Yokohama, Japan
Shintaro Furugori
Affiliation:
Department of Emergency Medicine, Yokohama City University Graduate School of Medicine, Yokohama, Japan
Takeru Abe
Affiliation:
Department of Emergency Medicine, Yokohama City University Graduate School of Medicine, Yokohama, Japan
Ichiro Takeuchi
Affiliation:
Department of Emergency Medicine, Yokohama City University Graduate School of Medicine, Yokohama, Japan
Corresponding
E-mail address:

Abstract

Introduction:

Triaging plays an important role in providing suitable care to a large number of casualties in a disaster setting. A Pediatric Physiological and Anatomical Triage Score (PPATS) was developed as a new secondary triage method. This study aimed to validate the accuracy of the PPATS in identifying injured pediatric patients who are admitted at a high frequency and require immediate treatment in a disaster setting. The PPATS method was also compared with the current triage methods, such as the Triage Revised Trauma Score (TRTS).

Methods:

A retrospective review of pediatric patients aged ≤15 years, registered in the Japan Trauma Data Bank (JTDB) from 2012 through 2016, was conducted and PPATS was performed. The PPATS method graded patients from zero to 22, and was calculated based on vital signs, anatomical abnormalities, and the need for life-saving interventions. It categorized patients based on their priority, and the intensive care unit (ICU)-indicated patients were assigned a PPATS ≥six. The accuracy of PPATS and TRTS in predicting the outcome of ICU-indicated patients was compared.

Results:

Of 2,005 pediatric patients, 1,002 (50%) were admitted to the ICU. The median age of the patients was nine years (interquartile range [IQR]: 6-13 years). The sensitivity and specificity of PPATS were 78.6% and 43.7%, respectively. The area under the receiver-operating characteristic (ROC) curve (AUC) was larger for PPATS (0.61; 95% confidence interval [CI], 0.59-0.63) than for TRTS (0.57; 95% CI, 0.56-0.59; P <.01). Regression analysis showed a significant correlation between PPATS and the Injury Severity Score (ISS; r2 = 0.353; P <.001), predicted survival rate (r2 = 0.396; P <.001), and duration of hospital stay (r2 = 0.252; P <.001).

Conclusion:

The accuracy of PPATS for injured pediatric patients was superior to that of current secondary triage methods. The PPATS method is useful not only for identifying high-priority patients, but also for determining the priority ranking for medical treatments and evacuation.

Type
Original Research
Copyright
© World Association for Disaster and Emergency Medicine 2019 

Access options

Get access to the full version of this content by using one of the access options below.

References

Advanced Life Support Group. Major Incident Medical Management and Support: The Practical Approach at the Scene. 3rd edition. Hoboken, New Jersey USA: Wiley-Blackwell; 2012.Google Scholar
Kelly, F. Keeping PEDIATRICS in pediatric disaster management: before, during, and in the aftermath of complex emergencies. Crit Care Nurs Clin North Am. 2010;22(4):465480.CrossRefGoogle ScholarPubMed
Smith, W. Triage in mass casualty situations. CME. 2012;30:413415.Google Scholar
Jones, N, White, ML, Tofil, N, et al. Randomized trial comparing two mass casualty triage systems (JumpSTART versus SALT) in a pediatric simulated mass casualty event. Prehosp Emerg Care. 2014;18(3):417423.CrossRefGoogle Scholar
Price, CL, Brace-McDonnell, SJ, Stallard, N, et al. Performance characteristics of five triage tools for major incidents involving traumatic injuries to children. Injury. 2016;47(5):988992.CrossRefGoogle Scholar
Toida, C, Muguruma, T, Hashimoto, K. Hospitals’ preparedness to treat pediatric patients during mass casualty incidents. Disaster Med Public Health Prep. 2018.CrossRefGoogle Scholar
Koziel, JR, Meckler, G, Brown, L, et al. Barriers to pediatric disaster triage: a qualitative investigation. Prehosp Emerg Care. 2015;19(2):279286.CrossRefGoogle ScholarPubMed
Heffernan, RW, Lerner, EB, McKee, CH, et al. Comparing the accuracy of mass casualty triage systems in a pediatric population. Prehosp Emerg Care. 2018.CrossRefGoogle Scholar
Toida, C, Muguruma, T, Abe, T, et al. Introduction of pediatric physiological and anatomical triage score in mass-casualty incident. Prehosp Disaster Med. 2018;33(2): 147152.CrossRefGoogle ScholarPubMed
Association for the Advancement of Automotive Medicine. The Abbreviated Injury Scale 1990 Revision - Update 1998. Des Plaines, Illinois USA: AAAM; 1998.Google Scholar
Fleming, S, Thompson, M, Stevens, R, et al. Normal ranges of heart rate and respiratory rate in children from birth to 18 years of age: a systematic review of observational studies. Lancet. 2011;377(9770):10111018.CrossRefGoogle ScholarPubMed
American Heart Association. Pears Provider Manual: Pediatric Emergency Assessment, Recognition and Stabilization. Dallas, Texas USA: AHA; 2012.Google Scholar
DeLong, ER, DeLong, DM, Clarke-Pearson, DL. Comparing the area under two or more correlated receiver operating characteristic curves: a nonparametric approach. Biometrics. 1988;44(3):837845.CrossRefGoogle ScholarPubMed
Donfrio, JJ, Kaji, AH, Cladius, IA, et al. Development of a pediatric mass casualty triage algorithm validation tool. Prehosp Emerg Care. 2016;20(3):343353.CrossRefGoogle Scholar
Supplementary material: Image

Muguruma et al. supplementary material

Appendix 1

Download Muguruma et al. supplementary material(Image)
Image 1 MB

Send article to Kindle

To send this article to your Kindle, first ensure no-reply@cambridge.org is added to your Approved Personal Document E-mail List under your Personal Document Settings on the Manage Your Content and Devices page of your Amazon account. Then enter the ‘name’ part of your Kindle email address below. Find out more about sending to your Kindle. Find out more about sending to your Kindle.

Note you can select to send to either the @free.kindle.com or @kindle.com variations. ‘@free.kindle.com’ emails are free but can only be sent to your device when it is connected to wi-fi. ‘@kindle.com’ emails can be delivered even when you are not connected to wi-fi, but note that service fees apply.

Find out more about the Kindle Personal Document Service.

Validation of the Pediatric Physiological and Anatomical Triage Score in Injured Pediatric Patients
Available formats
×

Send article to Dropbox

To send this article to your Dropbox account, please select one or more formats and confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your <service> account. Find out more about sending content to Dropbox.

Validation of the Pediatric Physiological and Anatomical Triage Score in Injured Pediatric Patients
Available formats
×

Send article to Google Drive

To send this article to your Google Drive account, please select one or more formats and confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your <service> account. Find out more about sending content to Google Drive.

Validation of the Pediatric Physiological and Anatomical Triage Score in Injured Pediatric Patients
Available formats
×
×

Reply to: Submit a response

Please enter your response.

Your details

Please enter a valid email address.

Conflicting interests

Do you have any conflicting interests? *