Abstract
Background: The pre-hospital evaluation criteria for children presenting as emergency cases were established in the Tokyo metropolitan region with the purpose of detecting pediatric patients requiring medical treatment at medical emergency centers, etc. and the practice thereof commenced in October 2009.
Purpose: Investigation into the validity of the pre-hospital evaluation criteria for children presenting as emergency cases.
Subjects: The subjects consisted of patients 15 years of age or younger who were directly transported to the National Center for Child Health and Development by ambulance during the 14-month period from February 2011 to March 2012.
Method: The medical records were retrospectively investigated. Emergency cases showing positive findings for pre-hospital evaluation items were defined as predictive cases. Emergency cases with no such positive items were defined as under-triage cases. Non-emergency cases with positive items were defined as over-triage cases.
Result: A total of 41 out of 2,707 cases were determined to be predictive cases. The great majority were endogenous cases, with central nervous system abnormalities the most common disease and abnormalities in the level of consciousness common as a positive item. A total of 69 out of 2,707 cases were classified as over-triage cases. Among these, 75% were febrile seizure cases. Meanwhile, 62 out of 2,707 cases were under-triage cases, in which the great majority patients suffering from trauma, anaphylaxis and seizures. Moreover, an association was observed between “circulatory failure” and the items included in the criteria. The sensitivity was 40% and the positive predictive value was 37%. As a result, adding the new items of “anaphylaxis” and “cluster seizures” to the pre-hospital evaluation criteria, and the adaptation of a trauma card, would thus allow the criteria to achieve a higher sensitivity, namely 75%.
Conclusion: Our findings indicated the low sensitivity of the current pre-hospital evaluation criteria for children presenting as emergency cases. In order to obtain a better sensitivity for such cases, we therefore propose the addition of two items to the pre-hospital evaluation criteria, namely “anaphylaxis” and “cluster seizures”, and the adaptation of a trauma card for trauma patients by the emergency team. Moreover, the items regarding “circulatory failure” for such child cases should also be reevaluated and modified as deemed necessary.
