Highlights
- •Evaluation of over/undertriage in pediatric patients transported by helicopter remains ill-defined.
- •NSP may augment the ISS/Cribari System in assessing triage accuracy in pediatric trauma patients transported by helicopter.
- •NSP, in addition to ISS, may lead to better resource utilization as it relates to helicopter transport.
Abstract
Background
When to transport pediatric trauma patients directly from scene to a trauma center
via helicopter (HT) has been a long debated topic. This study proposes Need for Surgeon
Presence (NSP) matrix as an alternative method to assess appropriate utilization of
HT of pediatric trauma patients directly from the scene of injury.
Method
We utilized the 2016 TQIP database. NSP was defined as having one or more of the following:
intubation, transfusion, operation for hemorrhage control/craniotomy, vasopressors,
interventional radiology, spinal cord injury, tube thoracostomy, emergency thoracotomy,
intracranial pressure monitor, or pericardiocentesis. The outcome of interest was
the presence or absence of a NSP indicator.
Results
The NSP + patients had a: longer LOS, GCS<14, positive SIPA index value, went to OR/ICU
from the ED, and had penetrating injury. Among patient with an ISS≥16, mortality for
those also NSP+ was 18.8% versus 1.4% among the NSP-.
Conclusion
The disparity between NSP and traditional ISS thresholds supports NSP as an additional
metric to validate pre-hospital triage criteria and may be a better indicator of overall
hospital resource utilization.
Keywords
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Article info
Publication history
Published online: November 29, 2019
Accepted:
November 22,
2019
Received in revised form:
November 19,
2019
Received:
June 24,
2019
Identification
Copyright
© 2019 Elsevier Inc. All rights reserved.
