Hostname: page-component-586b7cd67f-g8jcs Total loading time: 0 Render date: 2024-11-21T07:30:57.593Z Has data issue: false hasContentIssue false
  • English
  • Français

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

Published online by Cambridge University Press:  25 July 2019

Takashi Muguruma ,
Chiaki Toida Open the ORCID record for Chiaki Toida [Opens in a new window] ,
Shintaro Furugori ,
Takeru Abe  and
Ichiro Takeuchi
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
*
Correspondence: Chiaki Toida, MD, PhD, Department of Emergency Medicine, Yokohama City University Graduate School of Medicine, 4-57 Urafune-cho Minami-ku Yokohama, 232-0024 Japan E-mail: [email protected]
Get access Rights & Permissions [Opens in a new window]

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.

Keywords

injured pediatric patientmass-casualty incidentphysiological and anatomical triagesecondary triageTriage Revised Trauma Score
Type
Original Research
Information
Prehospital and Disaster Medicine , Volume 34 , Issue 4 , August 2019 , pp. 363 - 369
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. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

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):465–480.CrossRefGoogle ScholarPubMed
Smith, W. Triage in mass casualty situations. CME. 2012;30:413–415.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):417–423.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):988–992.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):279–286.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): 147–152.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):1011–1018.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):837–845.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):343–353.CrossRefGoogle Scholar
Supplementary material: Image

Muguruma et al. supplementary material

Appendix 1

Download Muguruma et al. supplementary material(Image)
Image 1.2 MB