ABSTRACTS
Evaluation of 2021 Field Triage Guidelines for Pediatric Patients Involved in Motor Vehicle CollisionsAuthor: Alissa Morrison BAS, Paramedic | Post-Crash Care Coordinator | Michigan Department of Health and Human Services Associate Authors: William Cebulskie, MS, NRP Sarah Domyan, NREMT Paramedic Julianne Ehlers, MA, CEM, MEP Tyson Astin, Paramedic Remle P. Crowe, PhD, NREMT David Wampler, PhD, Paramedic
Background: Motor vehicle collisions (MVC) remain a leading cause of injury and death among children in the US. The 2021 Field Triage Guidelines (FTG) were updated to improve prehospital identification of seriously injured patients and include Red Criteria (injury patterns or mental status/vital signs) indicating transport to the highest-level trauma center, and Yellow Criteria (mechanism of injury or EMS judgment) recommending transport to any trauma center. Limited evidence exists regarding performance in pediatric populations, particularly in MVC. We aimed to evaluate the predictive characteristics of the 2021 FTG in identifying severely injured children involved in MVCs. Methods: We conducted a retrospective analysis using the 2023 ESO Data Collaborative. Records from 6/1/2023-12/31/2023, were included to allow for FTG adoption following their February 2023 software release. We included 9-1-1 transports of patients <18 years of age involved in MVC with available emergency department (ED) data. The primary outcome was injury severity score (ISS) >15, calculated using ICDPIC-R to convert ED diagnosis codes. We calculated sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) for two conditions: (1) any FTG criteria met and (2) any Red Criteria met. Results: Of 24,522 pediatric MVC transports by 1,881 agencies, 820 (3%) by 60 agencies included FTG documentation; 491 (60%) had linked ED disposition. Median age was 11 years (IQR: 6-16) and 56% (n=274) were female. Overall, 4% (n=18) had ISS>15. Nearly one-fourth (23%,n=113) met any FTG criteria while 5% (n=24) met at least one Red criteria. Mechanism of injury was most commonly documented (18%,n=88), followed by EMS judgment (10%,n=49), mental status/vital signs (3%,n=16) and injury patterns (2%, n=12). Red Criteria demonstrated high specificity (96%) with lower sensitivity (33%) for identifying patients with ISS >15 (PPV 29%, NPV 97%). Including any FTG criteria increased sensitivity to 72% and decreased specificity to 78% (PPV 13%, NPV 98%). Conclusion: One-in-four severely injured pediatric MVC patients had no documented FTG criteria. Red Criteria were highly specific but lacked sensitivity, while using any FTG criteria improved sensitivity with a corresponding drop in specificity. Limitations include small sample size and reliance on diagnosis codes to identify severe injury.
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