M. Zeeshan1, M. Hamidi1, T. O’Keeffe1, N. Kulvatunyou1, A. Tang1, E. Zakaria1, L. Gries1, A. Northcutt1, B. Joseph1 1University Of Arizona,Trauma And Acute Care Surgery,Tucson, AZ, USA
Introduction:
Systolic-blood-pressure (SBP) <90 mm-Hg is one of the criteria for trauma center need (TCN) in the national trauma triage protocol (NTTP). The aim of our study was to determine the impact of substituting SBP<90 with shock-index (SI)>1 on triage performance.
Methods:
We performed a 2-year (2014–2015) analysis of all pediatric trauma patients (age<17 y) in the pediatric TQIP. Our outcome measure was TCN (ISS≥16, need for an emergent-operation, death in the emergency department, or ICU stay>1d). AUROC and triage characteristics were compared between SBP<90 and SI>1.0. Regression analysis was performed to compare the mortality between patients triaged under the current protocol of SBP<90 and patients triaged using the newly defined protocol (SI>1.0).
Results:
We included 60,842 patients. Compared with SBP<90, SI>1.0 had a higher sensitivity (57.2% vs. 42%) but lower specificity (73.3% vs. 81.5%) for TCN. Substituting SBP<90 mm Hg with SI>1.0 resulted in a decrease in under-triage rate of 2494 patients (4.1%) but an increase in over-triage of only 912 patients (1.5%). There was no difference in aOR mortality between the new and old triaged positive system (OR: 1.01 [0.95-1.08]).
Conclusion:
Appropriate triage of pediatric trauma patients will lead to better outcomes. Utilizing SI>1instead of SBP<90 mm-Hg in the NTTP results in significant reduction in under-triage rate without causing a large increase in over triage. SI is simple to use and has a better discriminatory power when compared to SBP.