Pediatric trauma specialists and statisticians at West Virginia University have formulated a measure to assess children with traumatic injuries more accurately to ensure they receive the most effective life-saving treatment. Their research was named one of the best studies of 2024 by a top medical journal. (WVU Photo)
West Virginia University pediatric trauma specialists and statisticians have formulated a measure to more accurately assess children with traumatic injuries to ensure they receive the most effective life-saving treatment.
“This tool we’ve evaluated is not only accurate in predicting which pediatric patients are going to benefit from going to a Level 1 trauma center, but it’s also simpler than ones that have been previously proposed so a paramedic can use it in the back of an ambulance,” said Tanner Smida, an MD/PhD student from Finleyville, Pennsylvania, whose studies focus on emergency medicine.
Smida, along with Dr. James Bardes, associate professor of trauma, acute care surgery and surgical critical care, and Dr. Patrick Bonasso, assistant professor and pediatric trauma director, both in the WVU School of Medicine Department of Surgery, came up with the concept for the study to augment the triage of children whose injuries occur in rural areas far from a trauma center. The formula for assessment, however, can be used in any setting to determine the need for critical care.
The Journal of Trauma and Acute Care Surgery, which published the paper, selected the study as one of the best of 2024. The work evolved from Bardes’ previous studies on adults with traumatic injuries, particularly those in rural states. Brad Price, chair and associate professor of management information systems and supply chain in the WVU John Chambers College of Business and Economics, was also a study co-author.
“When a child is injured, the most important first decision made by arriving EMTs and paramedics is where they are going to take the patient,” Smida said. “This tool gives us a simple and highly accurate way to identify high-risk pediatric trauma patients and send them to the right place, which can have an impact on their outcome.”
The team of WVU researchers evaluated the reverse shock index or rSIM score, which includes the ratio of systolic blood pressure to heart rate, and the motor skills component of the Glasgow Coma Scale or GSC, a tool to assess level of consciousness.
“We know the motor component is the most predictive, the most consistent across the age range for children,” Bardes said. “And it’s just easier.”
To conduct the study, Price said researchers looked at the National Trauma Data Bank to understand the relationship between rSIM scores, pediatric mortality and hospital resource utilization nationwide. Their approach investigated patients ages 1 to 16 and accounted for information such as age, gender and injury severity.
Traumatic injuries in youths can result from vehicle and ATV accidents, falls and acts of violence.
Smida said first responders could use the tool to assess an accident victim by dividing the patient’s blood pressure by their heart rate. That number would be multiplied by their GCS score, a figure determined by whether motor skills are present, such as being able to give a thumbs up.
“Imagine the scenario of a 6-year-old boy being struck by a car at low speed while crossing an intersection,” Smida said. “The EMTs perform a rapid trauma assessment and acquire an initial set of vital signs, including a blood pressure and heart rate. One of the EMTs asks the patient if he can ‘give a thumbs up,’ and he does.
“From this basic set of information, these EMTs would already be able to calculate the rSIM score. His systolic blood pressure is 90 mmHg, his heart rate is 118 beats per minute, and his ability to give a thumbs up indicates that he can follow commands, which corresponds to a score of six on the motor component of the Glasgow Coma Scale. A few taps on a phone calculator, dividing blood pressure by heart rate and then multiplying by the motor GCS, yields an rSIM score of 4.6.”
Emergency personnel would then call WVU Medical Command and provide information on the accident and rSIM score.
“In the future, using the data from our paper, that physician may be able to reference the optimal rSIM threshold that predicts the need for specialized trauma center care for the patient’s age group,” Smida said. “In this scenario, we can imagine that the optimal threshold value is five. Because the patient’s calculated rSIM value is below that threshold at 4.6, the physician decides the patient needs to be seen at the specialized pediatric center due to a high probability of serious injury.”
Smida explained that it’s important to select the proper level of care because otherwise patients can be either overtriaged, meaning they receive more intensive care than is needed, or undertriaged without access to facilities and health care providers to give life-saving treatment.
“If you overtriage a patient who doesn’t actually have severe injuries by putting them in a helicopter and flying them hours away across the state to a Level 1 trauma center, you’ve kind of harmed the patient in a couple of ways,” Smida said. “You’ve taken them far away from their family and imposed a pretty significant financial burden, and you’ve also increased the resource utilization at the trauma center.
“On the other hand, if you underestimate the injuries of that patient and you just take them to the local hospital that’s 10 minutes down the road, then that patient is not going to get access to timely blood transfusion or access to surgeons they need in order to stabilize them and save their lives,” Smida said.
Results were able to accurately predict a patient’s chance of survival, along with the need for blood transfusion, intensive care unit admission or surgery, Smida noted.
Bonasso said the study will also help hospitals prepare for receiving patients at certain trauma levels.
“We’re talking about interventions that happen in the emergency department, like blood transfusions, or whether there’s a need for procedures in the operating room,” he said.
Bonasso said he would like to see the next phase of the study involve educating pre-hospital providers, particularly those in West Virginia and the region, on how to use the tool. He also expects to see other researchers use the WVU team’s findings in their own studies.
Within the next few months, the WVU team will partner with the pediatric trauma clinical collaborative ATOMAC+ Pediatric Trauma Research Network to conduct an expanded study.
“We’re going to look at more granular data with hopes of making this a lot more accurate and validating different populations,” Bardes said. “Hopefully it will make an impact nationwide.”
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ls/1/3/25
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