Prehospital and Emergency Department Vital Sign Abnormalities Among Injured Children

Vital signs are a critical component in the assessment of the injured child. We compared vital sign abnormalities among injured children in the prehospital setting to those in the emergency department (ED) and evaluated the predictive value of each for the presence of major trauma. We performed a multi-agency and multicenter retrospective study of injured children within a county-based emergency medical services (EMS) system between 2010 and 2021, including injured children (<18 years) transported to the hospital. We compared prehospital vital signs for heart rate (HR), respiratory rate (RR), and systolic blood pressure (SBP) in the prehospital and ED setting. Using the Standard Triage Assessment Tool to define major trauma, we constructed multivariable models to evaluate the association of prehospital and ED vital sign abnormalities for major trauma. We included 21,298 encounters (median age 13 years, IQR 6-16), with major trauma was present in 3,606 (16.9%). In the prehospital setting, abnormal vital signs were reported in 25.7% for HR, 14.6% for RR, and 24.3% for SBP. ED measurements recorded a higher proportion of abnormal HR (28.2%) and RR (21.3%), and slightly lower proportion with abnormal SBP (21.8%). Cohen’s Kappa was fair for HR (0.27) and SBP (0.20), but slight for RR (0.09). Prehospital vital signs most strongly associated with major trauma included tachypnea (odds ratio [OR] 2.7, 95% confidence interval (CI 2.4–3.1) and bradypnea (OR 1.7, 95% CI 1.4–1.9). ED vital signs most strongly associated with major trauma included hypotension (OR 2.4, 95% CI 2.1–2.7) and tachypnea (OR 1.8, 95% CI 1.6–2.0). Prehospital and ED vital signs demonstrated similar performance in predicting major trauma (area under the receiver operator characteristic curve (AUROC 0.63); 95% CI 0.61–0.64 for prehospital; 0.63; 95% CI, 0.61–0.64 for ED). When combining prehospital and ED vital signs into a single model, predictive power increased (AUROC 0.66, 95% CI 0.65–0.67). We identified poor correlation between prehospital and ED vital signs. In both settings, vital sign abnormalities were associated with major trauma. The combined use of prehospital and ED vital signs improved predictive value for major trauma, suggesting potential for future integration into trauma triage tools.