Association between blood pressure recording in prehospital setting and patient outcome in pediatric trauma patients: A propensity score matching study.

ABSTRACT

BACKGROUND: Rapid identification of the severity of injuries in the field is important to ensure appropriate hospital care for better outcomes. Vital signs are used as a field triage tool for critically ill or injured patients in prehospital settings. Several studies have shown that recording vital signs, especially blood pressure, in pediatric patients is sometimes omitted in prehospital settings compared with that in adults. However, little is known about the association between the lack of measurement of prehospital vital signs and patient outcomes. In this study, we examined the association between the rate of vital sign measurements in the field and patient outcomes in injured children. METHODS: This study analyzed secondary data from the Japan Trauma Data Bank. We included pediatric patients (0-17 years) with injuries who were transported by emergency medical services. Hospital survival was the primary outcome. We performed a propensity-matched analysis with nearest-neighbor matching without replacement by adjusting for demographic and clinical variables to evaluate the effect of recording vital signs. RESULTS: During the study period, 13,413 pediatric patients were included. There were 9,187 and 1,798 patients with and without prehospital blood pressure records, respectively. After matching, there were no differences in the patient characteristics or disease severity. Hospital mortality was significantly higher in the nonrecorded group than in the recorded group (4.3% vs. 1.1%; p < 0.001). The multiple logistic regression analysis results showed no prehospital record of blood pressure being associated with death (odds ratio [OR], 6.82; 95% confidence interval [CI], 2.40-19.33). Glasgow Coma Scale score and Injury Severity Score were also associated with death (OR, 0.71; 95% CI, 0.63-0.81 and OR, 1.10; 95% CI, 1.06-11.14, respectively). CONCLUSION: Pediatric patients without any blood pressure records in prehospital settings had higher mortality rates than those with prehospital blood pressure records. LEVEL OF EVIDENCE Therapeutic/Care Management; Level III.