a1 Department of Pediatrics, Kosair Children's Hospital, University of Louisville, Louisville, Kentucky USA
a2 Department of Pediatrics, Yale-New Haven Hospital, Yale School of Medicine, New Haven, Connecticut USA
Introduction 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.
Purpose Evaluate the STM's performance in pediatric trauma victims.
Methods 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.
Results 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.
Conclusion 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.
Cross KP, Cicero MX. Independent application of the Sacco Disaster Triage Method to pediatric trauma patients. Prehosp Disaster Med. 2012;27(4):1-6.
(Received February 19 2012)
(Accepted May 03 2012)
(Online publication July 05 2012)
c1 Correspondence: Keith P. Cross, MD, MS, MSc Department of Pediatrics Kosair Children's Hospital University of Louisville 571 S Floyd St, Ste. 300 Louisville, KY 40202 USA E-mail firstname.lastname@example.org
Funding and conflicts of interest: The study was unfunded, and neither author has any conflict of interest.