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Introduction of Pediatric Physiological and Anatomical Triage Score in Mass-Casualty Incident

Published online by Cambridge University Press:  12 February 2018

Chiaki Toida ,
Takashi Muguruma ,
Takeru Abe ,
Mafumi Shinohara ,
Masayasu Gakumazawa ,
Naoki Yogo ,
Aya Shirasawa  and
Naoto Morimura
Chiaki Toida*
Affiliation:
Department of Emergency Medicine, Yokohama City University Graduate School of Medicine, Yokohama, Japan
Takashi Muguruma
Affiliation:
Department of Emergency Medicine, Yokohama City University Graduate School of Medicine, Yokohama, Japan
Takeru Abe
Affiliation:
Department of Emergency Medicine, Yokohama City University Graduate School of Medicine, Yokohama, Japan
Mafumi Shinohara
Affiliation:
Department of Emergency Medicine, Yokohama City University Graduate School of Medicine, Yokohama, Japan
Masayasu Gakumazawa
Affiliation:
Department of Emergency Medicine, Yokohama City University Graduate School of Medicine, Yokohama, Japan
Naoki Yogo
Affiliation:
Department of Emergency Medicine, Yokohama City University Graduate School of Medicine, Yokohama, Japan
Aya Shirasawa
Affiliation:
Department of Emergency Medicine, Yokohama City University Graduate School of Medicine, Yokohama, Japan
Naoto Morimura
Affiliation:
Department of Emergency Medicine, Yokohama City University Graduate School of Medicine, Yokohama, Japan
*
Correspondence: Chiaki Toida, MDDepartment of Emergency MedicineYokohama City University Graduate School of Medicine 4-57 Urafune-cho Minami-ku Yokohama, 232-0024 Japan E-mail: toida-ygc@umin.ac.jp
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Abstract

Background

Triage has an important role in providing suitable care to the largest number of casualties in a disaster setting, but there are no secondary triage methods suitable for children. This study developed a new secondary triage method named the Pediatric Physiological and Anatomical Triage Score (PPATS) and compared its accuracy with current triage methods.

Methods

A retrospective chart review of pediatric patients under 16 years old transferred to an emergency center from 2014 to 2016 was performed. The PPATS categorized the patients, defined the intensive care unit (ICU)-indicated patients if the category was highest, and compared the accuracy of prediction of ICU-indicated patients among PPATS, Physiological and Anatomical Triage (PAT), and Triage Revised Trauma Score (TRTS).

Results

Among 137 patients, 24 (17.5%) were admitted to ICU. The median PPATS score of these patients was significantly higher than that of patients not admitted to ICU (11 [IQR: 9-13] versus three [IQR: 2-4]; P<.001). The optimal cut-off value of the PPTAS was six, yielding a sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of 95.8%, 86.7%, 60.5%, and 99.0%. The area under the receiver-operating characteristic curve (AUC) was larger for PPTAS than for PAT or TRTS (0.95 [95% CI, 0.87-1.00] versus 0.65 [95% CI, 0.58-0.72]; P<.001 and 0.79 [95% CI, 0.69-0.89]; P=.003, respectively). Regression analysis showed a significant association between the PPATS and the predicted mortality rate (r2=0.139; P<.001), ventilation time (r2=0.320; P<.001), ICU stay (r2=0.362; P<.001), and hospital stay (r2=0.308; P<.001).

Conclusions

The accuracy of PPATS was superior to other methods for secondary triage of children.

ToidaC, MugurumaT, AbeT, ShinoharaM, GakumazawaM, YogoN, ShirasawaA, MorimuraN. Introduction of Pediatric Physiological and Anatomical Triage Score in Mass-Casualty Incident. Prehosp Disaster Med. 2018;33(2):147–152.

Keywords

critically ill childrenmass-casualty incidentphysiological and anatomical triagesecondary triagetriage revised trauma score
Type
Original Research
Information
Prehospital and Disaster Medicine , Volume 33 , Issue 2 , April 2018 , pp. 147 - 152
Copyright
© World Association for Disaster and Emergency Medicine 2018 

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Footnotes

Conflicts of interest/funding: This work was funded by JSPS KAKENHI Grant Number 17K17064 [Grant-in-Aid for Young scientists (B)]. The authors declare no conflicts of interest.

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