Hostname: page-component-cd9895bd7-dzt6s Total loading time: 0 Render date: 2024-12-25T06:09:22.996Z Has data issue: false hasContentIssue false
  • English
  • Français

Independent Application of the Sacco Disaster Triage Method to Pediatric Trauma Patients

Published online by Cambridge University Press:  05 July 2012

Keith P. Cross  and
Mark X. Cicero
Keith P. Cross*
Affiliation:
Department of Pediatrics, Kosair Children's Hospital, University of Louisville, Louisville, Kentucky USA
Mark X. Cicero
Affiliation:
Department of Pediatrics, Yale-New Haven Hospital, Yale School of Medicine, New Haven, Connecticut USA
*
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 [email protected]
Get access Rights & Permissions [Opens in a new window]

Abstract

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.

Keywords

disasterpediatricregistrytraumatriage
Type
Original Research
Information
Prehospital and Disaster Medicine , Volume 27 , Issue 4 , August 2012 , pp. 306 - 311
Copyright
Copyright © World Association for Disaster and Emergency Medicine 2012

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

1. Nocera, A, Garner, A. An Australian mass casualty incident triage system for the future based upon triage mistakes of the past: the Homebush Triage Standard. Aust N Z J Surg. 1999;69(8):603-608.CrossRefGoogle ScholarPubMed
2. SALT mass casualty triage: concept endorsed by the American College of Emergency Physicians, American College of Surgeons Committee on Trauma, American Trauma Society, National Association of EMS Physicians, National Disaster Life Support Education Consortium, and State and Territorial Injury Prevention Directors Association. Disaster Med Public Health Prep. 2008;2(4):245-246.CrossRefGoogle Scholar
3. Benson, M, Koenig, KL, Schultz, CH. Disaster triage: START, then SAVE—a new method of dynamic triage for victims of a catastrophic earthquake. Prehosp Disaster Med. 1996;11(2):117-124.CrossRefGoogle ScholarPubMed
4. Romig, LE. Pediatric triage. A system to JumpSTART your triage of young patients at MCIs. JEMS. 2002;27(7):52-58, 60-63.Google ScholarPubMed
5. Navin, DM, Sacco, WJ, McCord, TB. Does START triage work? The answer is clear! Ann Emerg Med. 2010;55(6):579-580; author reply 580-581.CrossRefGoogle ScholarPubMed
6. Kahn, CA, Schultz, CH, Miller, KT, Anderson, CL. Does START triage work? An outcomes assessment after a disaster. Ann Emerg Med. 2009;54(3):424-430, 30 e1.CrossRefGoogle Scholar
7. de Ceballos, JP, Turegano-Fuentes, F, Perez-Diaz, D, Sanz-Sanchez, M, Martin-Llorente, C, Guerrero-Sanz, JE. 11 March 2004: The terrorist bomb explosions in Madrid, Spain—an analysis of the logistics, injuries sustained and clinical management of casualties treated at the closest hospital. Crit Care. 2005;9(1):104-111.CrossRefGoogle ScholarPubMed
8. Jenkins, JL, McCarthy, ML, Sauer, LM, et al. . Mass-casualty triage: time for an evidence-based approach. Prehosp Disaster Med. 2008;23(1):3-8.CrossRefGoogle ScholarPubMed
9. Zoraster, R. Disaster triage: is it time to stop START? Am J Disaster Med. 2006;1(1):7-9.CrossRefGoogle ScholarPubMed
10. Sacco, WJ, Navin, DM, Fiedler, KE, Waddell, RK 2nd, Long, WB, Buckman, RF Jr. Precise formulation and evidence-based application of resource-constrained triage. Acad Emerg Med. 2005;12(8):759-770.Google ScholarPubMed
11. Sacco, WJ, Navin, DM, Waddell, RK 2nd, Fiedler, KE, Long, WB, Buckman, RF Jr. A new resource-constrained triage method applied to victims of penetrating injury. J Trauma. 2007;63(2):316-325.Google ScholarPubMed
12. Baker, SP, O'Neill, B, Haddon, W Jr., Long, WB. The injury severity score: a method for describing patients with multiple injuries and evaluating emergency care. J Trauma. 1974;14(3):187-196.CrossRefGoogle ScholarPubMed
13. Garner, A, Lee, A, Harrison, K, Schultz, CH. Comparative analysis of multiple-casualty incident triage algorithms. Ann Emerg Med. 2001;38(5):541-548.CrossRefGoogle ScholarPubMed
14. Wallis, LA, Carley, S. Comparison of paediatric major incident primary triage tools. Emerg Med J. 2006;23(6):475-478.CrossRefGoogle ScholarPubMed