• F E Lecky, A Ardolino, R Cheung, K Berry, A Chaudhury, S Issa, N Koralage, and I K Maconochie.
• School of Paediatrics, London Deanery, London, United Kingdom.
• Emerg Med J. 2013 Oct 1;30(10):867.

Objectives & BackgroundPre-hospital triage is becoming increasingly important as Regional Trauma Networks for children are implemented in England. The low incidence of trauma in children makes pre-hospital assessment of injury severity and where to send an injured child challenging. Currently there are few validated pre-hospital triage tools for children's trauma and no consensus on which to use. We investigate performance characteristics of pre-hospital paediatric triage tools currently in use in England for identifying injured children.MethodsWe identified a total of eight pre-hospital paediatric triage tools (six in current usage in England). Each tool was interrogated using 701 retrospective clinical episodes from the Trauma Audit and Research Network (TARN-representing severely injured children) and from 2934 patient records in four English Emergency Departments (representing moderate to minor injuries). Target rates for under- and over-triage were set as <5% and <25-50% respectively.ResultsFrom TARN data, two triage tools demonstrated acceptable under-triage rates (3% and 4%) for severe injuries but unacceptable over-triage of moderate injuries (83% and 72%). Two tools demonstrated acceptable over-triage (7% and 16%) with unacceptable under-triage (61% and 63%). Four tools demonstrated unacceptable under- and over-triage. For moderate and minor injuries, three tools demonstrated acceptable under- and over-triage rates (all 0%). The other five tools had unacceptable under-triage rates (25-100%). All eight tools had acceptable over-triage rates (1%-21%). (See tables 1 and 2) Abstract 004 Table 1Performance characteristics of pre-hospital paediatric trauma triage tools-TARN/severe injuries ToolnISS>15Undertriage rate (%)Overtriage rate (%)East Midlands701230383London472North West780Northern977South West London; Surrey1259Wessex3923Paediatric Trauma Score617Paediatric Triage Tape283946316 Abstract 004 Table 2Performance characteristics of pre-hospital paediatric trauma triage tools-Moderate/minor injuries ToolnISS>15Undertriage (%)Overtriage (%)East Midlands29344018London2511North West021Northern019South West London; Surrey509Wessex507Paediatric Trauma Score1001Paediatric Triage Tape18114753 CONCLUSION: For severe injuries, none of the pre-hospital triage tools for injured children currently used in England meet recommended criteria for over- and under-triage rates. For moderate to minor injuries, all tools achieved acceptable over-triage rates but tended to under-triage. There is an urgent need for development of triage tools to accurately risk-stratify injured children in the pre-hospital setting.

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