Stable pediatric blunt trauma patients: Is trauma team activation always necessary?

Background: An increasing number of studies on adult trauma patients have questioned the need for trauma team activation for stable patients dictated only by mechanism of injury. This triage approach seems to burden the limited resources of the trauma center and may prove to be cost-ineffective. The objective of our study was to determine the predictive value and the sensitivity and specificity of blunt injury mechanism for major trauma in stable pediatric trauma patients. Methods: Patients 0 to 14 years old injured by injury mechanisms modified from the American College of Surgeons trauma triage criteria and presenting to our American College of Surgeons-verified regional pediatric trauma center from the field between July 1, 1993, and July 31, 1994, were included. Physiologically and anatomically stable patients were identified and subgroup analysis was performed to determine the negative and positive predictive value and sensitivity, and the specificity of blunt injury mechanisms for major trauma [ Injury Severity Score > 15] in this group. Results: One hundred ninety-four patients met the study criteria. One hundred forty-three patients (73.6%) had trauma team activation only for mechanism of injury. Of these patients, four patients had Injury Severity Score > 15, The positive and negative predictive values of injury mechanisms modified from the American College of Surgeons trauma triage criteria were 2.8% and 90.2%, respectively, for major trauma in stable pediatric blunt trauma patients. The sensitivity and specificity were 44.4% and 24.9%, respectively. Conclusion: Mechanisms of injury seem to hare limited value as predictors of injury severity in stable pediatric blunt trauma patients, A modified response level for these patients may prove to be a safe and practical alternative to current practice.