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J Korean Soc Emerg Med > Volume 28(6); 2017 > Article
Journal of The Korean Society of Emergency Medicine 2017;28(6): 579-586.
고위험외상 선별도구로서 변형소아점수와 새롭게 고안된 확장된 변형소아외상점수의 유용성: 두 단계에 의한 외상팀 활성화 지지
강문철1, 왕일재1*, 조석주1, 염석란1, 한상균1, 박성욱1, 이성화1, 박순창1, 이대섭2, 조현민3
1부산대학교병원 응급의학과
2양산부산대학교병원 응급의학과
3부산대학교병원 외상중환자외과
The Usefulness of the mPTS (modified pediatric trauma score) and Newly Developed Extended mPTS as a High Risk Pediatric Trauma Patients Screening Tool: Support of Two Tiered Trauma Team Activation System
Moon Cheol Kang1, Il Jae Wang1*, Suck Ju Cho1, Seok Ran Yeom1, Sang Kyoon Han1, Sung Wook Park1, Seong Hwa Lee1, Soon Chang Park1, Dae Sup Lee2, Hyun Min Cho3
1Department of Emergency Medicine, Pusan National University Hospital, Busan, Korea
2Department of Emergency Medicine, Pusan National University Yangsan Hospital, Yangsan, Korea
3Department of Trauma and Surgical Critical Care, Pusan National University Hospital, Busan, Korea
Correspondence  Il Jae Wang ,Tel: 051-240-7503, Fax: 051-253-6472, Email: jrmr9933@gmail.com,
Received: July 4, 2017; Revised: July 5, 2017   Accepted: October 2, 2017.  Published online: December 31, 2017.
A secondary triage tool for pediatric trauma patients, “modified pediatric trauma score (mPTS)” was introduced to predict high risk trauma.
Pediatric trauma patients (≤15 years) presenting to the Pusan National University Hospital trauma center emergency department were analyzed retrospectively. The patients were classified into high risk and low risk groups. The high risk group was assigned an Injury Severity Score ≥12, death, intensive care unit admission, or urgent intervention (intubation, closed thoracostomy, emergency angiography and embolization, emergency surgery). The airway, blood pressure, fractures, level of consciousness, and external wounds were evaluated and the mPTS was calculated.
One hundred seventy-seven patients were enrolled in this study. The mPTS had a sensitivity, specificity, positive predictive value, and negative predictive value of 88%, 54%, 60%, and 85%, respectively. Overtriage and undertriage was 39% and 14%, respectively. The mPTS missed 6 high risk patients and all 6 patients were abdominal injury patients. The mPTS was modified to include an abdominal physical examination and/or focused assessment with sonography for trauma. The newly developed scoring system was called the extended mPTS (E-mPTS). The E-mPTS had a sensitivity of 98% and negative predictive value of 98%. The safe level of overtriage (38%) was maintained.
mPTS was applied to the patients and the undertriage rate was too high. The extended mPTS improved undertriage to 2% while maintaining the overtriage rate at a safe level. The E-mPTS is expected to have a resource saving effect when used as a pediatric trauma team activation standard.
Key words: Wounds and injuries, Triage, Pediatrics, Emergency medicine
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