Independent Application of the Sacco Disaster Triage Method to Pediatric Trauma Patients
Though many mass-casualty triage methods have been proposed, few have been validated in an evidence-based manner. The Sacco Triage Method (STM) has been shown to accurately stratify adult victims of blunt and penetrating trauma into groups of increasing mortality risk. However, it has not been valid...
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| Veröffentlicht in: | Prehospital and disaster medicine 2012-08, Vol.27 (4), p.306-311 |
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| creator | Cross, Keith P. Cicero, Mark X. |
| description | Though many mass-casualty triage methods have been proposed, few have been validated in an evidence-based manner. The Sacco Triage Method (STM) has been shown to accurately stratify adult victims of blunt and penetrating trauma into groups of increasing mortality risk. However, it has not been validated for pediatric trauma victims.
Evaluate the STM's performance in pediatric trauma victims.
Records from the United States' National Trauma Data Base, a registry of trauma victims developed by the American College of Surgeons, were extracted for the 2007-2009 reporting years. Patients ≤ 18 years of age transported from a trauma scene with complete initial scene data were included in the analysis. Sacco triage scores were assigned to each registry patient, and receiver-operator curves were developed for predicting mortality, along with several secondary outcomes. Area under the receiver-operator curve (AUC) was the main outcome statistic. Sensitivity analysis was performed using a Sacco score without age adjustment, using blunt versus penetrating trauma, and using patients |
| doi_str_mv | 10.1017/S1049023X12000866 |
| format | Article |
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Evaluate the STM's performance in pediatric trauma victims.
Records from the United States' National Trauma Data Base, a registry of trauma victims developed by the American College of Surgeons, were extracted for the 2007-2009 reporting years. Patients ≤ 18 years of age transported from a trauma scene with complete initial scene data were included in the analysis. Sacco triage scores were assigned to each registry patient, and receiver-operator curves were developed for predicting mortality, along with several secondary outcomes. Area under the receiver-operator curve (AUC) was the main outcome statistic. Sensitivity analysis was performed using a Sacco score without age adjustment, using blunt versus penetrating trauma, and using patients <12 years of age.
There were 210,175 pediatric records, of which 90,037 had complete data for analysis. The STM with age adjustment predicted pediatric trauma mortality with an AUC of 0.933 (95% CI: 0.925-0.940). Without the age adjustment term, it predicted mortality with an AUC of 0.924 (95% CI: 0.916-0.933). The STM with age adjustment predicted blunt trauma mortality in 72,467 patients with an AUC of 0.938 (95% CI: 0.929-0.947) and penetrating trauma mortality in 10,099 patients with an AUC of 0.927 (95% CI: 0.911-0.943). These findings did not change significantly when analysis was limited to patients <12 years of age. The Sacco Triage Method was also predictive of some secondary outcomes, such as major injury and death on arrival to the emergency department.
The Sacco Triage Method, with or without its age adjustment term, was a highly accurate predictor of mortality in pediatric trauma patients in this registry database. This triage method appears to be a valid strategy for the prioritization of injured children.</description><identifier>ISSN: 1049-023X</identifier><identifier>EISSN: 1945-1938</identifier><identifier>DOI: 10.1017/S1049023X12000866</identifier><identifier>PMID: 22874578</identifier><language>eng</language><publisher>New York, USA: Cambridge University Press</publisher><subject>Adolescent ; Area Under Curve ; Child ; Child, Preschool ; Emergency medical services ; Emergency Medical Services - organization & administration ; Evidence-Based Medicine ; Female ; Health risks ; Health technology assessment ; Humans ; Infant ; Infant, Newborn ; Male ; Methods ; Mortality risk ; Pediatrics ; Pediatrics - methods ; Priorities ; Registries ; ROC Curve ; Sensitivity analysis ; Trauma care ; Trauma Severity Indices ; Triage - methods ; United States - epidemiology ; Wounds and Injuries - classification ; Wounds and Injuries - epidemiology</subject><ispartof>Prehospital and disaster medicine, 2012-08, Vol.27 (4), p.306-311</ispartof><rights>Copyright © World Association for Disaster and Emergency Medicine 2012</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c373t-f94469fca94b14f6bac9953769e2d8bb2926e8c105a3a565f87bce376d8f98c13</citedby><cites>FETCH-LOGICAL-c373t-f94469fca94b14f6bac9953769e2d8bb2926e8c105a3a565f87bce376d8f98c13</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktohtml>$$Uhttps://www.cambridge.org/core/product/identifier/S1049023X12000866/type/journal_article$$EHTML$$P50$$Gcambridge$$H</linktohtml><link.rule.ids>164,314,780,784,27924,27925,55628</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/22874578$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Cross, Keith P.</creatorcontrib><creatorcontrib>Cicero, Mark X.</creatorcontrib><title>Independent Application of the Sacco Disaster Triage Method to Pediatric Trauma Patients</title><title>Prehospital and disaster medicine</title><addtitle>Prehosp Disaster Med</addtitle><description>Though many mass-casualty triage methods have been proposed, few have been validated in an evidence-based manner. The Sacco Triage Method (STM) has been shown to accurately stratify adult victims of blunt and penetrating trauma into groups of increasing mortality risk. However, it has not been validated for pediatric trauma victims.
Evaluate the STM's performance in pediatric trauma victims.
Records from the United States' National Trauma Data Base, a registry of trauma victims developed by the American College of Surgeons, were extracted for the 2007-2009 reporting years. Patients ≤ 18 years of age transported from a trauma scene with complete initial scene data were included in the analysis. Sacco triage scores were assigned to each registry patient, and receiver-operator curves were developed for predicting mortality, along with several secondary outcomes. Area under the receiver-operator curve (AUC) was the main outcome statistic. Sensitivity analysis was performed using a Sacco score without age adjustment, using blunt versus penetrating trauma, and using patients <12 years of age.
There were 210,175 pediatric records, of which 90,037 had complete data for analysis. The STM with age adjustment predicted pediatric trauma mortality with an AUC of 0.933 (95% CI: 0.925-0.940). Without the age adjustment term, it predicted mortality with an AUC of 0.924 (95% CI: 0.916-0.933). The STM with age adjustment predicted blunt trauma mortality in 72,467 patients with an AUC of 0.938 (95% CI: 0.929-0.947) and penetrating trauma mortality in 10,099 patients with an AUC of 0.927 (95% CI: 0.911-0.943). These findings did not change significantly when analysis was limited to patients <12 years of age. The Sacco Triage Method was also predictive of some secondary outcomes, such as major injury and death on arrival to the emergency department.
The Sacco Triage Method, with or without its age adjustment term, was a highly accurate predictor of mortality in pediatric trauma patients in this registry database. This triage method appears to be a valid strategy for the prioritization of injured children.</description><subject>Adolescent</subject><subject>Area Under Curve</subject><subject>Child</subject><subject>Child, Preschool</subject><subject>Emergency medical services</subject><subject>Emergency Medical Services - organization & administration</subject><subject>Evidence-Based Medicine</subject><subject>Female</subject><subject>Health risks</subject><subject>Health technology assessment</subject><subject>Humans</subject><subject>Infant</subject><subject>Infant, Newborn</subject><subject>Male</subject><subject>Methods</subject><subject>Mortality risk</subject><subject>Pediatrics</subject><subject>Pediatrics - methods</subject><subject>Priorities</subject><subject>Registries</subject><subject>ROC Curve</subject><subject>Sensitivity analysis</subject><subject>Trauma care</subject><subject>Trauma Severity Indices</subject><subject>Triage - methods</subject><subject>United States - epidemiology</subject><subject>Wounds and Injuries - classification</subject><subject>Wounds and Injuries - epidemiology</subject><issn>1049-023X</issn><issn>1945-1938</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2012</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><sourceid>ABUWG</sourceid><sourceid>AFKRA</sourceid><sourceid>BENPR</sourceid><sourceid>CCPQU</sourceid><recordid>eNp1kEtLxDAUhYMovn-AGwm4cVPNo02T5TA-QXFgFNyVNL3VyLSpSbrw35thRhHFTW7I-c7J5SB0RMkZJbQ8n1OSK8L4M2WEECnEBtqlKi8yqrjcTPckZ0t9B-2F8EYIUwUT22iHMVnmRSl30fNt38AA6egjngzDwhodreuxa3F8BTzXxjh8YYMOETx-9Fa_AL6H-OoaHB2eQWN19NYkSY-dxrNkT1nhAG21ehHgcD330dPV5eP0Jrt7uL6dTu4yw0ses1bluVCt0Sqvad6KWhulCl4KBayRdc0UEyANJYXmuhBFK8vaQNIb2ar0zvfR6Sp38O59hBCrzgYDi4XuwY2hokQSwVXqKaEnv9A3N_o-bbekGKFKyTxRdEUZ70Lw0FaDt532HwmqlrVXf2pPnuN18lh30Hw7vnpOAF-H6q72tnmBn3__F_sJ9RmLpw</recordid><startdate>201208</startdate><enddate>201208</enddate><creator>Cross, Keith P.</creator><creator>Cicero, Mark X.</creator><general>Cambridge University Press</general><general>Jems Publishing Company, Inc</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>3V.</scope><scope>7RV</scope><scope>7X7</scope><scope>7XB</scope><scope>88C</scope><scope>88E</scope><scope>8C1</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>BENPR</scope><scope>CCPQU</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>K9.</scope><scope>KB0</scope><scope>M0S</scope><scope>M0T</scope><scope>M1P</scope><scope>NAPCQ</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>7X8</scope></search><sort><creationdate>201208</creationdate><title>Independent Application of the Sacco Disaster Triage Method to Pediatric Trauma Patients</title><author>Cross, Keith P. ; Cicero, Mark X.</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c373t-f94469fca94b14f6bac9953769e2d8bb2926e8c105a3a565f87bce376d8f98c13</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2012</creationdate><topic>Adolescent</topic><topic>Area Under Curve</topic><topic>Child</topic><topic>Child, Preschool</topic><topic>Emergency medical services</topic><topic>Emergency Medical Services - organization & administration</topic><topic>Evidence-Based Medicine</topic><topic>Female</topic><topic>Health risks</topic><topic>Health technology assessment</topic><topic>Humans</topic><topic>Infant</topic><topic>Infant, Newborn</topic><topic>Male</topic><topic>Methods</topic><topic>Mortality risk</topic><topic>Pediatrics</topic><topic>Pediatrics - methods</topic><topic>Priorities</topic><topic>Registries</topic><topic>ROC Curve</topic><topic>Sensitivity analysis</topic><topic>Trauma care</topic><topic>Trauma Severity Indices</topic><topic>Triage - methods</topic><topic>United States - epidemiology</topic><topic>Wounds and Injuries - classification</topic><topic>Wounds and Injuries - epidemiology</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Cross, Keith P.</creatorcontrib><creatorcontrib>Cicero, Mark X.</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>ProQuest Central (Corporate)</collection><collection>Nursing & Allied Health Database</collection><collection>Health & Medical Collection</collection><collection>ProQuest Central (purchase pre-March 2016)</collection><collection>Healthcare Administration Database (Alumni)</collection><collection>Medical Database (Alumni Edition)</collection><collection>Public Health Database</collection><collection>Hospital Premium Collection</collection><collection>Hospital Premium Collection (Alumni Edition)</collection><collection>ProQuest Central (Alumni) (purchase pre-March 2016)</collection><collection>ProQuest Central (Alumni Edition)</collection><collection>ProQuest Central UK/Ireland</collection><collection>ProQuest Central</collection><collection>ProQuest One Community College</collection><collection>Health Research Premium Collection</collection><collection>Health Research Premium Collection (Alumni)</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Nursing & Allied Health Database (Alumni Edition)</collection><collection>Health & Medical Collection (Alumni Edition)</collection><collection>Healthcare Administration Database</collection><collection>Medical Database</collection><collection>Nursing & Allied Health Premium</collection><collection>ProQuest One Academic Eastern Edition (DO NOT USE)</collection><collection>ProQuest One Academic</collection><collection>ProQuest One Academic UKI Edition</collection><collection>MEDLINE - Academic</collection><jtitle>Prehospital and disaster medicine</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Cross, Keith P.</au><au>Cicero, Mark X.</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Independent Application of the Sacco Disaster Triage Method to Pediatric Trauma Patients</atitle><jtitle>Prehospital and disaster medicine</jtitle><addtitle>Prehosp Disaster Med</addtitle><date>2012-08</date><risdate>2012</risdate><volume>27</volume><issue>4</issue><spage>306</spage><epage>311</epage><pages>306-311</pages><issn>1049-023X</issn><eissn>1945-1938</eissn><abstract>Though many mass-casualty triage methods have been proposed, few have been validated in an evidence-based manner. The Sacco Triage Method (STM) has been shown to accurately stratify adult victims of blunt and penetrating trauma into groups of increasing mortality risk. However, it has not been validated for pediatric trauma victims.
Evaluate the STM's performance in pediatric trauma victims.
Records from the United States' National Trauma Data Base, a registry of trauma victims developed by the American College of Surgeons, were extracted for the 2007-2009 reporting years. Patients ≤ 18 years of age transported from a trauma scene with complete initial scene data were included in the analysis. Sacco triage scores were assigned to each registry patient, and receiver-operator curves were developed for predicting mortality, along with several secondary outcomes. Area under the receiver-operator curve (AUC) was the main outcome statistic. Sensitivity analysis was performed using a Sacco score without age adjustment, using blunt versus penetrating trauma, and using patients <12 years of age.
There were 210,175 pediatric records, of which 90,037 had complete data for analysis. The STM with age adjustment predicted pediatric trauma mortality with an AUC of 0.933 (95% CI: 0.925-0.940). Without the age adjustment term, it predicted mortality with an AUC of 0.924 (95% CI: 0.916-0.933). The STM with age adjustment predicted blunt trauma mortality in 72,467 patients with an AUC of 0.938 (95% CI: 0.929-0.947) and penetrating trauma mortality in 10,099 patients with an AUC of 0.927 (95% CI: 0.911-0.943). These findings did not change significantly when analysis was limited to patients <12 years of age. The Sacco Triage Method was also predictive of some secondary outcomes, such as major injury and death on arrival to the emergency department.
The Sacco Triage Method, with or without its age adjustment term, was a highly accurate predictor of mortality in pediatric trauma patients in this registry database. This triage method appears to be a valid strategy for the prioritization of injured children.</abstract><cop>New York, USA</cop><pub>Cambridge University Press</pub><pmid>22874578</pmid><doi>10.1017/S1049023X12000866</doi><tpages>6</tpages></addata></record> |
| fulltext | fulltext |
| identifier | ISSN: 1049-023X |
| ispartof | Prehospital and disaster medicine, 2012-08, Vol.27 (4), p.306-311 |
| issn | 1049-023X 1945-1938 |
| language | eng |
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| source | MEDLINE; Cambridge Journals |
| subjects | Adolescent Area Under Curve Child Child, Preschool Emergency medical services Emergency Medical Services - organization & administration Evidence-Based Medicine Female Health risks Health technology assessment Humans Infant Infant, Newborn Male Methods Mortality risk Pediatrics Pediatrics - methods Priorities Registries ROC Curve Sensitivity analysis Trauma care Trauma Severity Indices Triage - methods United States - epidemiology Wounds and Injuries - classification Wounds and Injuries - epidemiology |
| title | Independent Application of the Sacco Disaster Triage Method to Pediatric Trauma Patients |
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