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Prospective Validation of an Out-of-hospital Decision Rule to Identify Seriously Injured Children Involved in Motor Vehicle Crashes
- Source :
- Academic Emergency Medicine. 12:679-687
- Publication Year :
- 2005
- Publisher :
- Wiley, 2005.
-
Abstract
- Objectives: To prospectively validate a previously published out-of-hospital clinical decision rule to identify seriously injured children involved in motor vehicle crashes (MVCs). Methods: The authors selected 20 Los Angeles County Fire Department fire stations, based on pediatric MVC call volume and geographic diversity, and 21 associated hospitals for participation in the study. Immediately following an MVC call involving a pediatric patient aged 0‐14 years, each engine/paramedic squad completed a data form (15 variables, including vital signs, Glasgow Coma Scale score, and vehicular and crash characteristics). This study was conducted over a 24-month period. Outcomes included: 1) ‘‘serious injury’’ as defined by an Injury Severity Score (ISS) $ 16 (primary outcome), and 2) need for specialized trauma care (emergent intubation, major nonorthopedic operative intervention or death in the first 24 hours, or pediatric intensive care unit stay longer than 48 hours), as assessed by retrospective chart review. Accuracy measures and binominal confidence intervals (CIs) were calculated for the decision rule validation. Results: One hundred seventy-five children were prospectively enrolled in the study; 36 children were excluded due to lack of hospital participation or missing hospital charts. There were four children with ISS $ 16 (3%) and six children requiring specialized trauma care (4%). The sensitivities and specificities of the rule were: 100% (95% CI = 40% to 100%) and 73% (95% CI = 65% to 81%) for serious injury, and 83% (95% CI = 36% to 100%) and 74% (95% CI = 65% to 81%) for specialized trauma care, respectively. Conclusions: Although definitive conclusions are limited by the sample size, the decision rule identified all seriously injured children involved in MVCs and had moderate specificity. The decision rule was less sensitive for identifying children requiring specialized trauma care. Larger validation studies are needed to adequately assess the utility of this rule before implementation. Key words: clinical decision rule; pediatrics; motor vehicle collisions; trauma; prediction. ACADEMIC EMERGENCY MEDICINE 2005; 12:679‐687.
- Subjects :
- Male
Emergency Medical Services
medicine.medical_specialty
Adolescent
Attitude of Health Personnel
Vital signs
Poison control
Sensitivity and Specificity
Occupational safety and health
Decision Support Techniques
Injury Severity Score
Injury prevention
Humans
Medicine
Glasgow Coma Scale
Prospective Studies
Child
Pediatric intensive care unit
business.industry
Accidents, Traffic
Infant, Newborn
Infant
General Medicine
Decision rule
Los Angeles
Transportation of Patients
Child, Preschool
Emergency medicine
Emergency Medicine
Wounds and Injuries
Female
Triage
business
Subjects
Details
- ISSN :
- 10696563
- Volume :
- 12
- Database :
- OpenAIRE
- Journal :
- Academic Emergency Medicine
- Accession number :
- edsair.doi.dedup.....dc3e07ec800d951af7b4711cf029a92b