Article Text

other Versions

Download PDFPDF
The accuracy of existing prehospital triage tools for injured children in England—an analysis using trauma registry data
  1. Ronny Cheung1,
  2. Antonella Ardolino2,
  3. Thomas Lawrence3,
  4. Omar Bouamra3,
  5. Fiona Lecky4,5,
  6. Kathleen Berry6,
  7. Mark D Lyttle7,
  8. Ian K Maconochie8
  1. 1Department of Paediatrics, St Thomas' Hospital, London, UK
  2. 2Department of Trauma & Orthopaedics, Portsmouth Hospitals NHS Trust, Portsmouth, UK
  3. 3The Trauma Audit and Research Network, University of Manchester, Hope Hospital, Salford, UK
  4. 4Health Services Research Group, School for Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK
  5. 5Salford Royal Hospital, Salford, UK
  6. 6Birmingham Children's Hospital, Birmingham, UK
  7. 7Bristol Royal Hospital for Children, Bristol, UK
  8. 8St Mary's Hospital, Imperial College NHS Healthcare Trust, London, UK
  1. Correspondence to Dr Ronny Cheung, Department of Paediatrics, St Thomas' Hospital, Westminster Bridge Rd, London SE1, UK; crcheung{at}


Objectives To investigate the performance characteristics of prehospital paediatric triage tools for identifying seriously injured children in England.

Design Eight prehospital paediatric triage tools were identified by literature review and by survey of the Lead Trauma Clinicians across English Strategic Health Authorities. Retrospective clinical registry data from the Trauma Audit and Research Network were used to determine the performance characteristics of each tool, using ‘gold standards’ for under- and over-triage of <5% and <25–50%, respectively, as benchmarks for performance.

Participants 701 patient records were included. Inclusion criteria were all injured patients aged <16 years admitted to a receiving unit direct from the scene of accident in the period 2007–2010, for whom all key discriminator fields were recorded in the Trauma Audit and Research Network database.

Outcome measures The main outcome measure was how each tool functioned with regard to their under- and over-triaging features. Other performance characteristics, for example, predictive values and likelihood ratios were also calculated.

Results Two (of eight) triage tools demonstrated acceptable under-triage rates (3% and 4%) but had unacceptably high over-triage rates (83% and 72%). Two tools demonstrated acceptable over-triage rates (7% and 16%), but with unacceptably high under-triage rates (61% and 63%). Four tools had unacceptably high under- and over-triage rates.

Conclusions None of the prehospital triage tools currently used or being developed in England meet recommended criteria for over- and under-triage rates. There is an urgent need for the development of triage tools to accurately risk-stratify injured children in the prehospital setting.

  • Trauma
  • major trauma management
  • paediatrics
  • paediatric emergency medicine
  • paediatric injury
  • paramedics
  • clinical management
  • statistics
  • epidemiology
  • clinical
  • effectiveness
  • clinical care
  • emergency department
  • paediatric emergency med
  • resuscitation
  • paediatric resuscitation
  • major incidents
  • emergency care systems

Statistics from

Request Permissions

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.


  • Competing interests None.

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

  • Data sharing statement Technical appendix, statistical code and dataset available from the corresponding author on request. Individual patient consent was not obtained but the presented data are anonymised and risk of identification is low.