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Evaluation of the criteria for trauma activation in the paediatric emergency department
  1. Jen Heng Pek1,
  2. Yong-Kwang Gene Ong2,
  3. En Ci Samuel Quek2,
  4. Xun Yi Jasmine Feng3,
  5. John Carson Allen Jr4,
  6. Shu-Ling Chong2
  1. 1 Department of Emergency Medicine, Sengkang General Hospital, Singapore, Singapore
  2. 2 Department of Emergency Medicine, KK Women’s and Children’s Hospital, Singapore, Singapore
  3. 3 Pediatric Surgery, KK Women’s and Children’s Hospital, Singapore, Singapore
  4. 4 Centre for Quantitative Medicine, Duke-NUS Medical School, Singapore, Singapore
  1. Correspondence to Dr Shu-Ling Chong, Department of Children’s Emergency, KK Women’s and Chlidren’s Hospital, Singapore 229899, Singapore; Chong.Shu-Ling{at}


Background Trauma team activation criteria have a variable performance in the paediatric population. We aimed to identify predictors for high-level resource utilisation during trauma resuscitation in the ED.

Methods A retrospective study was conducted in the ED of a tertiary paediatric hospital. Patient data were collected from trauma surveillance registry and analysis was performed to identify significant predictors. We then assessed the sensitivity and specificity of proposed models with respect to observed patient outcomes.

Results Among 11 282 cases, the mean age was 6.1±4.9 (SD) years old. Fall was the most common mechanism of injury in 7364 (65.3%) patients. Eighty-eight (0.8%) patients required at least one high-level resource. Significant predictors for high-resource utilisation were overall GCS of <14 (relative risk (RR) 38.841, 95% CI 21.328 to 70.739, p<0.001), high-risk mechanisms of fall from height and motor vehicle collision (RR 7.863, 95% CI 4.687 to 13.192, p<0.001), as well as age-specific tachycardia (RR 1.796, 95% CI 1.145 to 2.817, p=0.0108). A model consisting of GCS and high-risk mechanism would under-triage 21 (0.2%) patients and over-triage 681 (6.0%) patients. When age-specific tachycardia was added, 8 (0.1%) less patients would be under-triaged but an additional 3251 (28.9%) patients would be over-triaged.

Conclusion As utilisation of high-level resources in paediatric trauma was rare, it was difficult to find an appropriate balance between under-triage and over-triage. Between the two, minimising the proportion of under-triage is more important as patient safety is paramount in paediatric trauma care.

  • paediatric emergency med
  • trauma
  • triage

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  • Contributors JHP: manuscript writing. GY-KO: review manuscript with input. ECSQ: aid data analysis, review manuscript with input. XYJF: data collection. JCA: data analysis. S-LC: data analysis, review manuscript with input.

  • Competing interests None declared.

  • Ethics approval Ethics approval was obtained from the Institutional Review Board at SingHealth, Singapore (CIRB reference 2018/2268).

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Patient consent for publication Not required.