Citation

Doud AN, Schoell SL, Talton JW, Barnard RT, Petty JK, Stitzel JD, Weaver AA. Accid. Anal. Prev. 2018; 113: 12-18.

Affiliation

Wake Forest School of Medicine, Medical Center Blvd, Winston-Salem, NC, 27157, United States; Virginia Tech-Wake Forest University Center for Injury Biomechanics, 575 N. Patterson Ave, Suite 120, Winston-Salem, NC, 27101, United States. Electronic address: asweaver@wakehealth.edu.

Copyright

(Copyright © 2018, Elsevier Publishing)

DOI

10.1016/j.aap.2017.12.025

PMID

29367055

Abstract

BACKGROUND: Occult injuries are those likely to be missed on initial assessment by first responders and, though initially asymptomatic, they may present suddenly and lead to rapid patient decompensation. No scoring systems to quantify the occultness of pediatric injuries have been established. Such a scoring system will be useful in the creation of an Advanced Automotive Crash Notification (AACN) system that assists first responders in making triage decisions following a motor vehicle crash (MVC). STUDY DESIGN: The most frequent MVC injuries were determined for 0-4, 5-9, 10-14 and 15-18 year olds. For each age-specific injury, experts with pediatric trauma expertise were asked to rate the likelihood that the injury may be missed by first responders. An occult score (ranging from 0-1) was calculated by averaging and normalizing the responses of the experts polled.

RESULTS: Evaluation of all injuries across all age groups demonstrated greater occult scores for the younger age groups compared to older age groups (mean occult score 0-4yo: 0.61 ± 0.23, 5-9yo: 0.53 ± 0.25, 10-14yo: 0.48 ± 0.23, and 15-18yo: 0.42 ± 0.22, p < 0.01). Body-region specific occult scores revealed that experts judged abdominal, spine and thoracic injuries to be more occult than injuries to other body regions.

CONCLUSIONS: The occult scores suggested that injuries are more difficult to detect in younger age groups, likely given their inability to express symptoms. An AACN algorithm that can predict the presence of clinically undetectable injuries at the scene can improve triage of children with these injuries to higher levels of care.

Copyright © 2018 Elsevier Ltd. All rights reserved.

Language: en

Keywords

AIS; Occult injuries; Pediatric motor vehicle crashes; Pediatric trauma triage