Prospective validation of an out-of-hospital decision rule to identify seriously injured children involved in motor vehicle crashes

Craig Newgard, Sai Hung Joshua Hui, Andrew Griffin, Melanie Wuerstle, Franklin Pratt, Roger J. Lewis

Research output: Contribution to journalArticle

22 Citations (Scopus)

Abstract

Objectives: To prospectively validate a previously published out-of-hospital clinical decision rule to identify seriously injured children involved in motor vehicle crashes (MVCs). Methods: The authors selected 20 Los Angeles County Fire Department fire stations, based on pediatric MVC call volume and geographic diversity, and 21 associated hospitals for participation in the study. Immediately following an MVC call involving a pediatric patient aged 0-14 years, each engine/paramedic squad completed a data form (15 variables, including vital signs, Glasgow Coma Scale score, and vehicular and crash characteristics). This study was conducted over a 24-month period. Outcomes included: 1) "serious injury" as defined by an Injury Severity Score (ISS) ≥ 16 (primary outcome), and 2) need for specialized trauma care (emergent intubation, major nonorthopedic operative intervention or death in the first 24 hours, or pediatric intensive care unit stay longer than 48 hours), as assessed by retrospective chart review. Accuracy measures and binominal confidence intervals (CIs) were calculated for the decision rule validation. Results: One hundred seventy-five children were prospectively enrolled in the study; 36 children were excluded due to lack of hospital participation or missing hospital charts. There were four children with ISS ≥ 16 (3%) and six children requiring specialized trauma care (4%). The sensitivities and specificities of the rule were: 100% (95% CI = 40% to 100%) and 73% (95% CI = 65% to 81%) for serious injury, and 83% (95% CI = 36% to 100%) and 74% (95% CI = 65% to 81%) for specialized trauma care, respectively. Conclusions: Although definitive conclusions are limited by the sample size, the decision rule identified all seriously injured children involved in MVCs and had moderate specificity. The decision rule was less sensitive for identifying children requiring specialized trauma care. Larger validation studies are needed to adequately assess the utility of this rule before implementation.

Original languageEnglish (US)
Pages (from-to)679-687
Number of pages9
JournalAcademic Emergency Medicine
Volume12
Issue number8
DOIs
StatePublished - Aug 2005

Fingerprint

Motor Vehicles
Confidence Intervals
Wounds and Injuries
Injury Severity Score
Pediatrics
Allied Health Personnel
Pediatric Intensive Care Units
Glasgow Coma Scale
Los Angeles
Vital Signs
Validation Studies
Intubation
Sample Size
Sensitivity and Specificity

Keywords

  • Clinical decision rule
  • Motor vehicle collisions
  • Pediatrics
  • Prediction
  • Trauma

ASJC Scopus subject areas

  • Emergency Medicine

Cite this

Prospective validation of an out-of-hospital decision rule to identify seriously injured children involved in motor vehicle crashes. / Newgard, Craig; Hui, Sai Hung Joshua; Griffin, Andrew; Wuerstle, Melanie; Pratt, Franklin; Lewis, Roger J.

In: Academic Emergency Medicine, Vol. 12, No. 8, 08.2005, p. 679-687.

Research output: Contribution to journalArticle

Newgard, Craig ; Hui, Sai Hung Joshua ; Griffin, Andrew ; Wuerstle, Melanie ; Pratt, Franklin ; Lewis, Roger J. / Prospective validation of an out-of-hospital decision rule to identify seriously injured children involved in motor vehicle crashes. In: Academic Emergency Medicine. 2005 ; Vol. 12, No. 8. pp. 679-687.
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