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Accuracy of Pediatric Trauma Field TriageA Systematic Review
JAMA Surgery ( IF 16.9 ) Pub Date : 2018-07-01 , DOI: 10.1001/jamasurg.2018.1050
Rogier van der Sluijs 1 , Eveline A. J. van Rein 1 , Joep G. J. Wijnand 1 , Luke P. H. Leenen 1 , Mark van Heijl 1, 2
Affiliation  

Importance Field triage of pediatric patients with trauma is critical for transporting the right patient to the right hospital. Mortality and lifelong disabilities are potentially attributable to erroneously transporting a patient in need of specialized care to a lower-level trauma center.

Objective To quantify the accuracy of field triage and associated diagnostic protocols used to identify children in need of specialized trauma care.

Evidence Review MEDLINE, Embase, PsycINFO, and Cochrane Register of Controlled Trials were searched from database inception to November 6, 2017, for studies describing the accuracy of diagnostic tests to identify children in need of specialized trauma care in a prehospital setting. Identified articles with a study population including patients not transported by emergency medical services were excluded. Quality assessment was performed using a modified version of the Quality Assessment of Diagnostic Accuracy Studies–2.

Findings After deduplication, 1430 relevant articles were assessed, a full-text review of 38 articles was conducted, and 5 of those articles were included. All studies were observational, published between 1996 and 2017, and conducted in the United States, and data collection was prospective in 1 study. Three different protocols were studied that analyzed a combined total of 1222 children in need of specialized trauma care. One protocol was specifically developed for a pediatric out-of-hospital cohort. The percentage of pediatric patients requiring specialized trauma care in each study varied between 2.6% (110 of 4197) and 54.7% (58 of 106). The sensitivity of the prehospital triage tools ranged from 49.1% to 87.3%, and the specificity ranged from 41.7% to 84.8%. No prehospital triage protocol alone complied with the international standard of 95% or greater sensitivity. Undertriage and overtriage rates, representative of the quality of the full diagnostic strategy to transport a patient to the right hospital, were not reported for inclusive trauma systems or emergency medical services regions.

Conclusions and Relevance It is crucial to transport the right patient to the right hospital. Yet the quality of the full diagnostic strategy to determine the optimal receiving hospital is unknown. None of the investigated field triage protocols complied with current sensitivity targets. Improved efforts are needed to develop accurate child-specific tools to prevent undertriage and its potential life-threatening consequences.



中文翻译:

小儿创伤现场分流的准确性系统评价

重要性 对有创伤的小儿患者进行现场分类对于将合适的患者运送到合适的医院至关重要。死亡和终身残疾可能是由于将需要专门护理的患者错误地运送到较低级别的创伤中心所致。

目的 量化用于识别需要特殊创伤护理的儿童的现场分类和相关诊断方案的准确性。

从数据库开始到2017年11月6日,对MEDLINE,Embase,PsycINFO和Cochrane对照试验注册进行证据检索,以研究描述诊断测试的准确性,以鉴定出院前需要特殊创伤护理的儿童。排除了具有研究人群(包括未通过紧急医疗服务转运的患者)的鉴定文章。使用诊断准确性研究质量评估-2的修订版进行质量评估。

发现 重复数据删除后,评估了1430篇相关文章,对38篇文章进行了全文评审,其中包括5篇。所有研究均为观察性研究,于1996年至2017年之间发表,并在美国进行,数据收集在1项研究中具有前瞻性。研究了三种不同的方案,对总共1222名需要专门创伤护理的儿童进行了分析。一种协议是专门为儿科院外队列开发的。在每项研究中,需要专门创伤护理的儿科患者百分比在2.6%(4197的110)和54.7%(106的58)之间变化。院前分诊工具的敏感性范围为49.1%至87.3%,特异性范围为41.7%至84.8%。没有任何院前分诊方案能够单独满足95%或更高敏感性的国际标准。对于包容性创伤系统或急诊医疗服务区域,未报告过流失率和过流率,该率代表将患者运送到正确的医院的完整诊断策略的质量。

结论和相关性 将正确的患者送往正确的医院至关重要。然而,确定最佳接收医院的完整诊断策略的质量尚不清楚。没有调查的现场分流协议符合当前的灵敏度目标。需要作出更大的努力来开发准确的针对儿童的工具,以防止未成年人及其潜在的威胁生命的后果。

更新日期:2018-07-19
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