Citation

Muguruma T, Toida C, Furugori S, Abe T, Takeuchi I. Prehosp. Disaster Med. 2019; 34(4): 363-369.

Affiliation

Department of Emergency Medicine, Yokohama City University Graduate School of Medicine,Yokohama,Japan.

Copyright

(Copyright © 2019, Cambridge University Press)

DOI

10.1017/S1049023X19004552

PMID

31340871

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.

Language: en

Keywords

AIS: Abbreviated Injury Scale; AUC: area under the receiver-operating characteristic curve; GCS: Glasgow Coma Score; HR: heart rate; ICU: intensive care unit; ISS: Injury Severity Score; JTDB: Japan Trauma Data Bank; NPV: negative predictive value; PPATS: Pediatric Physiological and Anatomical Triage Score; PPV: positive predictive value; ROC: receiver-operating characteristic; RR: respiratory rate; TRTS: Triage Revised Trauma Score; sBP: systolic blood pressure; Triage Revised Trauma Score; injured pediatric patient; mass-casualty incident; physiological and anatomical triage; secondary triage