Comparison of Vital Sign Cutoffs to Identify Children With Major Trauma
An erratum to this article was published (JAMA Netw Open, 1 Aug 2024 ↗)
Authors' conclusion
These findings suggest that empirically derived vital sign criteria strike a balance between the sensitivity of PALS criteria and the specificity of ATLS criteria in identifying major trauma in children.
Study context
- Population
- Severely injured children (<18 years) at US trauma centers, excluding out-of-hospital cardiac arrest, mechanical ventilation or transfer3,223 (4.6%) major trauma
- Participants
- 70,748 participants
- Exposure
- Pediatric Advanced Life Support (PALS) vs Advanced Trauma Life Support (ATLS) vs Empirically derived
- Outcome
- Major trauma (Standard Triage Assessment Tool: composite of injury severity and interventions), discrimination by AUC
Methodological detailsregistry (2021 Trauma Quality Improvement Program (TQIP)), validation in 2019 TQIP dataset
- Registry (2021 TQIP)
- Validation in 2019 TQIP dataset
Main finding
As reported in the abstract
Identification of major trauma
| Group | AUC | Sensitivity | Specificity |
|---|---|---|---|
| PALS | 69.6% (95% CI, 68.6%-70.6%) | 88.4% (95% CI, 87.1%-89.3%)Sensitivity on a scale from 0 to 100 percent | 25.1% (95% CI, 24.7%-25.4%)Specificity on a scale from 0 to 100 percent |
| ATLS | 65.4% (95% CI, 64.4%-66.3%) | 54.5% (95% CI, 52.7%-56.2%)Sensitivity on a scale from 0 to 100 percent | 72.9% (95% CI, 72.6%-73.3%)Specificity on a scale from 0 to 100 percent |
| Empirically derived | 70.9% (95% CI, 69.9%-71.8%) | 80.0% (95% CI, 78.5%-81.3%)Sensitivity on a scale from 0 to 100 percent | 48.7% (95% CI, 48.3%-49.1%)Specificity on a scale from 0 to 100 percent |
AUC
PALS69.6% (95% CI, 68.6%-70.6%)
ATLS65.4% (95% CI, 64.4%-66.3%)
Empirically derived70.9% (95% CI, 69.9%-71.8%)
Sensitivity
PALS88.4% (95% CI, 87.1%-89.3%)
ATLS54.5% (95% CI, 52.7%-56.2%)
Empirically derived80.0% (95% CI, 78.5%-81.3%)
Sensitivity on a scale from 0 to 100 percentSpecificity
PALS25.1% (95% CI, 24.7%-25.4%)
ATLS72.9% (95% CI, 72.6%-73.3%)
Empirically derived48.7% (95% CI, 48.3%-49.1%)
Specificity on a scale from 0 to 100 percentObservational data: associations, not effects.
Further findings
| Outcome | PALS | ATLS |
|---|---|---|
| Vital signs classified as abnormal (HR, respiratory rate, SBP) | ||
| Abnormal HR | 31.0% | 25.3% |
| Abnormal respiratory rate | 25.7% | 4.3% |
| Abnormal SBP | 57.4% | 1.1% |
Validation (2019 TQIP)
- Similar performance to the derivation sample
Original publication
Comparison of Vital Sign Cutoffs to Identify Children With Major Trauma. JAMA Netw Open. Published 5 February 2024. doi:10.
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