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Purpose <p>To evaluate differing vital signs criteria for the prediction of major trauma in children.</p> Methods <p>We conducted a multicenter retrospective cohort study including children (&lt; 18 years) from the 2019–2022 Japan Trauma Data Bank. We compared Pediatric Advanced Life Support (PALS), Advanced Trauma Life Support (ATLS), and empirically-derived criteria for first-measured emergency department vital signs. The primary outcome was major trauma, defined as having an elevated Injury Severity Score and meeting Need for Trauma Intervention criteria (mortality, transfusion, intensive care unit admission, mechanical ventilation, and/or performance of surgery or interventional radiology procedure). We evaluated the diagnostic accuracy of each criterion and their performance in a multivariable logistic regression model.</p> Results <p>Of 3,798 children included, 417 (11.0%) had major trauma. For heart rate, all criteria showed similar performance (sensitivity 42.2–45.3%, specificity 75.4–79.2%). For respiratory rate, ATLS had low sensitivity (10.6%, 95% confidence interval [CI] 7.8–13.9%) but high specificity (94.1%, 95% CI 93.2–94.8%). PALS and empirically-derived criteria had moderate sensitivity (~ 60%) and specificity (~ 60%). For systolic blood pressure, PALS had higher sensitivity (68.2%, 95% CI 63.5–72.7%) but lower specificity (42.5%, 95% 37.4–47.1%) than empirically derived cutoffs; ATLS had low sensitivity (12.5%, 95% CI 9.5–16.0%) but very high specificity (98.3%, 95% CI 97.8–98.7%). Multivariable area under the receiver operator characteristic curves were 0.65 for PALS, 0.68 for empirically derived, and 0.63 for ATLS.</p> Conclusion <p>PALS and empirically-derived criteria outperformed ATLS in identifying children with major trauma. These findings signal an opportunity to refine vital sign thresholds in pediatric trauma triage.</p>

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Evaluating age-based vital sign cutoffs for pediatric trauma: a multicenter evaluation of the Japanese trauma data bank

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  • 发表日期：

    2025年10月28日

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  • Mafumi Shinohara,
  • Takeru Abe,
  • Jillian K. Gorski,
  • Sriram Ramgopal

摘要

Purpose

To evaluate differing vital signs criteria for the prediction of major trauma in children.

Methods

We conducted a multicenter retrospective cohort study including children (< 18 years) from the 2019–2022 Japan Trauma Data Bank. We compared Pediatric Advanced Life Support (PALS), Advanced Trauma Life Support (ATLS), and empirically-derived criteria for first-measured emergency department vital signs. The primary outcome was major trauma, defined as having an elevated Injury Severity Score and meeting Need for Trauma Intervention criteria (mortality, transfusion, intensive care unit admission, mechanical ventilation, and/or performance of surgery or interventional radiology procedure). We evaluated the diagnostic accuracy of each criterion and their performance in a multivariable logistic regression model.

Results

Of 3,798 children included, 417 (11.0%) had major trauma. For heart rate, all criteria showed similar performance (sensitivity 42.2–45.3%, specificity 75.4–79.2%). For respiratory rate, ATLS had low sensitivity (10.6%, 95% confidence interval [CI] 7.8–13.9%) but high specificity (94.1%, 95% CI 93.2–94.8%). PALS and empirically-derived criteria had moderate sensitivity (~ 60%) and specificity (~ 60%). For systolic blood pressure, PALS had higher sensitivity (68.2%, 95% CI 63.5–72.7%) but lower specificity (42.5%, 95% 37.4–47.1%) than empirically derived cutoffs; ATLS had low sensitivity (12.5%, 95% CI 9.5–16.0%) but very high specificity (98.3%, 95% CI 97.8–98.7%). Multivariable area under the receiver operator characteristic curves were 0.65 for PALS, 0.68 for empirically derived, and 0.63 for ATLS.

Conclusion

PALS and empirically-derived criteria outperformed ATLS in identifying children with major trauma. These findings signal an opportunity to refine vital sign thresholds in pediatric trauma triage.