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If emergency medical technicians (EMTs) on the scene of a motor vehicle crash (MVC) simply evaluate a child's degree of consciousness (coma score), extent of passenger space intrusion from the other car or object, and appropriate use of seatbelt or other restraint, they can identify seriously injured children and properly triage them to pediatric trauma centers. This triage approach could potentially prevent 80 fatalities per year in children younger than 16 years involved in MVCs, concludes the largest pediatric MVC trauma triage study to date. The study was supported in part by the Agency for Healthcare Research and Quality (National Research Service Award fellowship F32 HS00148).
Craig D. Newgard, M.D., M.P.H., of the Harbor-University of California, Los Angeles Medical Center, and his colleagues analyzed a national database produced from crash team investigators to study 8,394 children up to 15 years of age who were involved in MVCs from 1993 through 1999. They selected 12 out-of-hospital factors, which were both available in the database and easily obtained by on-scene EMTs, to analyze as potential predictors of severity of injury: age, sex, weight, Glasgow Coma Scale (GCS) score (a cumulative measure of level of consciousness and degree of dysfunction reflected in eye opening, verbal response, and motor response), primary point of vehicular impact, rollover, magnitude of passenger space intrusion (PSI), intrusion location, restraint use, seat location, entrapment, and air bag deployment.
The researchers found that a GCS score less than 15 (15 is no impairment, 7 indicates coma, and 3 brain death), PSI of 6 inches or more, and lack of appropriate restraint use predicted severe injury in children (Injury Severity Score of 16 or more) with a sensitivity of 92 percent and specificity of 73 percent. Of children with a GCS score less than 15, 62 percent were seriously injured. A PSI of 6 inches or more identified an additional 23 seriously injured children. Finally, in children with a normal GCS score and minimal (less than 6 inches) or no PSI, lack of appropriate restraint use suggested a higher probability of severe injury.
For details, see "Use of out-of-hospital variables to predict severity of injury in pediatric patients involved in motor vehicle crashes," by Dr. Newgard, Roger J. Lewis, M.D., Ph.D., and B. Tilman Jolly, M.D., in the May 2002 Annals of Emergency Medicine 39(1), pp. 481-491.
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