{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,2,10]],"date-time":"2026-02-10T19:22:46Z","timestamp":1770751366384,"version":"3.50.0"},"reference-count":24,"publisher":"Springer Science and Business Media LLC","issue":"1","license":[{"start":{"date-parts":[[2025,10,28]],"date-time":"2025-10-28T00:00:00Z","timestamp":1761609600000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2025,10,28]],"date-time":"2025-10-28T00:00:00Z","timestamp":1761609600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["Eur J Trauma Emerg Surg"],"published-print":{"date-parts":[[2025,12]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Purpose<\/jats:title>\n                    <jats:p>To evaluate differing vital signs criteria for the prediction of major trauma in children.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We conducted a multicenter retrospective cohort study including children (&lt;\u200918 years) from the 2019\u20132022 Japan Trauma Data Bank. We compared Pediatric Advanced Life Support (PALS), Advanced Trauma Life Support (ATLS), and empirically-derived criteria for first-measured emergency department vital signs. The primary outcome was major trauma, defined as having an elevated Injury Severity Score and meeting Need for Trauma Intervention criteria (mortality, transfusion, intensive care unit admission, mechanical ventilation, and\/or performance of surgery or interventional radiology procedure). We evaluated the diagnostic accuracy of each criterion and their performance in a multivariable logistic regression model.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Of 3,798 children included, 417 (11.0%) had major trauma. For heart rate, all criteria showed similar performance (sensitivity 42.2\u201345.3%, specificity 75.4\u201379.2%). For respiratory rate, ATLS had low sensitivity (10.6%, 95% confidence interval [CI] 7.8\u201313.9%) but high specificity (94.1%, 95% CI 93.2\u201394.8%). PALS and empirically-derived criteria had moderate sensitivity (~\u200960%) and specificity (~\u200960%). For systolic blood pressure, PALS had higher sensitivity (68.2%, 95% CI 63.5\u201372.7%) but lower specificity (42.5%, 95% 37.4\u201347.1%) than empirically derived cutoffs; ATLS had low sensitivity (12.5%, 95% CI 9.5\u201316.0%) but very high specificity (98.3%, 95% CI 97.8\u201398.7%). Multivariable area under the receiver operator characteristic curves were 0.65 for PALS, 0.68 for empirically derived, and 0.63 for ATLS.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>PALS and empirically-derived criteria outperformed ATLS in identifying children with major trauma. These findings signal an opportunity to refine vital sign thresholds in pediatric trauma triage.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1007\/s00068-025-02985-6","type":"journal-article","created":{"date-parts":[[2025,10,28]],"date-time":"2025-10-28T11:19:19Z","timestamp":1761650359000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Evaluating age-based vital sign cutoffs for pediatric trauma: a multicenter evaluation of the Japanese trauma data bank"],"prefix":"10.1007","volume":"51","author":[{"given":"Mafumi","family":"Shinohara","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Takeru","family":"Abe","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jillian K.","family":"Gorski","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sriram","family":"Ramgopal","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"297","published-online":{"date-parts":[[2025,10,28]]},"reference":[{"issue":"9946","key":"2985_CR1","doi-asserted-by":"publisher","first-page":"915","DOI":"10.1016\/S0140-6736(14)60581-X","volume":"384","author":"P Sidebotham","year":"2014","unstructured":"Sidebotham P, Fraser J, Covington T, Freemantle J, Petrou S, Pulikottil-Jacob R, et al. Understanding why children die in high-income countries. Lancet. 2014;384(9946):915\u201327.","journal-title":"Lancet"},{"issue":"25","key":"2985_CR2","doi-asserted-by":"publisher","first-page":"2468","DOI":"10.1056\/NEJMsr1804754","volume":"379","author":"RM Cunningham","year":"2018","unstructured":"Cunningham RM, Walton MA, Carter PM. The major causes of death in children and adolescents in the United States. N Engl J Med. 2018;379(25):2468\u201375.","journal-title":"N Engl J Med"},{"key":"2985_CR3","doi-asserted-by":"crossref","unstructured":"Newgard CD, Fischer PE, Gestring M, Michaels HN, Jurkovich GJ, Lerner EB et al. National guideline for the field triage of injured patients: recommendations of the National expert panel on field triage, 2021. J Trauma Acute Care Surg. 2022:10\u20131097.","DOI":"10.1097\/TA.0000000000003627"},{"issue":"1","key":"2985_CR4","first-page":"1","volume":"61","author":"SM Sasser","year":"2012","unstructured":"Sasser SM, Hunt RC, Faul M, Sugerman D, Pearson WS, Dulski T, et al. Guidelines for field triage of injured patients: recommendations of the National expert panel on field Triage, 2011. Morbidity and mortality weekly report. Recommendations Rep. 2012;61(1):1\u201320.","journal-title":"Recommendations Rep"},{"issue":"2","key":"2985_CR5","doi-asserted-by":"publisher","first-page":"180","DOI":"10.1080\/10903127.2016.1233311","volume":"21","author":"EB Lerner","year":"2017","unstructured":"Lerner EB, Drendel AL, Cushman JT, Badawy M, Shah MN, Guse CE, et al. Ability of the physiologic criteria of the field triage guidelines to identify children who need the resources of a trauma center. Prehosp Emerg Care. 2017;21(2):180\u20134.","journal-title":"Prehosp Emerg Care"},{"issue":"2","key":"2985_CR6","first-page":"1","volume":"28","author":"S Ramgopal","year":"2023","unstructured":"Ramgopal S, Sepanski RJ, Crowe RP, Martin-Gill C. External validation of empirically derived vital signs in children and comparison to other vital signs classification criteria. Prehosp Emerg Care. 2023;28(2):1\u201315.","journal-title":"Prehosp Emerg Care"},{"key":"2985_CR7","volume-title":"Pediatric advanced life support provider manual","author":"American Heart Association","year":"2020","unstructured":"American Heart Association. Pediatric advanced life support provider manual. Dallas, TX: American Heart Association; 2020."},{"key":"2985_CR8","first-page":"42","volume-title":"ATLS student course manual: advanced trauma life support","author":"American College of Surgeons","year":"2018","unstructured":"American College of Surgeons. Shock. In: ATLS student course manual: advanced trauma life support. Chicago, IL: American College of Surgeons; 2018. p. 42\u201361."},{"issue":"1","key":"2985_CR9","doi-asserted-by":"publisher","first-page":"22","DOI":"10.29045\/14784726.2019.06.4.1.22","volume":"4","author":"L Thompson","year":"2019","unstructured":"Thompson L, Hill M, Shaw G. Defining major trauma: a literature review. Br Paramed J. 2019;4(1):22\u201330.","journal-title":"Br Paramed J"},{"issue":"4","key":"2985_CR10","doi-asserted-by":"publisher","first-page":"402","DOI":"10.1016\/j.annemergmed.2022.09.019","volume":"81","author":"S Ramgopal","year":"2023","unstructured":"Ramgopal S, Sepanski RJ, Martin-Gill C. Empirically derived age-based vital signs for children in the out-of-hospital setting. Ann Emerg Med. 2023;81(4):402\u201312. https:\/\/doi.org\/10.1016\/j.annemergmed.2022.09.019.","journal-title":"Ann Emerg Med"},{"issue":"2","key":"2985_CR11","doi-asserted-by":"publisher","DOI":"10.1001\/jamanetworkopen.2023.56472","volume":"7","author":"JK Gorski","year":"2024","unstructured":"Gorski JK, Chaudhari PP, Spurrier RG, Goldstein SD, Zeineddin S, Martin-Gill C, et al. Comparison of vital sign cutoffs to identify children with major trauma. JAMA Netw Open. 2024;7(2):e2356472. https:\/\/doi.org\/10.1001\/jamanetworkopen.2023.56472.","journal-title":"JAMA Netw Open"},{"key":"2985_CR12","doi-asserted-by":"publisher","DOI":"10.1136\/tsaco-2018-000247","author":"S Matsumoto","year":"2018","unstructured":"Matsumoto S, Jung K, Smith A, Yamazaki M, Kitano M, Coimbra R. Comparison of trauma outcomes between Japan and the USA using national trauma registries. Trauma Surg Acute Care Open. 2018. https:\/\/doi.org\/10.1136\/tsaco-2018-000247.","journal-title":"Trauma Surg Acute Care Open"},{"issue":"9596","key":"2985_CR13","doi-asserted-by":"publisher","first-page":"1453","DOI":"10.1016\/S0140-6736(07)61602-X","volume":"370","author":"E Von Elm","year":"2007","unstructured":"Von Elm E, Altman DG, Egger M, Pocock SJ, G\u00f8tzsche PC, Vandenbroucke JP. The strengthening the reporting of observational studies in epidemiology (STROBE) statement: guidelines for reporting observational studies. Lancet. 2007;370(9596):1453\u20137.","journal-title":"Lancet"},{"issue":"3","key":"2985_CR14","doi-asserted-by":"publisher","first-page":"443","DOI":"10.1016\/j.injury.2020.09.027","volume":"52","author":"JW Roden-Foreman","year":"2021","unstructured":"Roden-Foreman JW, Rapier NR, Foreman ML, Cribari C, Parsons M, Zagel AL, et al. Avoiding Cribari gridlock 2: the standardized triage assessment tool outperforms the Cribari matrix method in 38 adult and pediatric trauma centers. Injury. 2021;52(3):443\u20139.","journal-title":"Injury"},{"issue":"3","key":"2985_CR15","doi-asserted-by":"publisher","first-page":"658","DOI":"10.1097\/TA.0000000000002402","volume":"87","author":"JW Roden-Foreman","year":"2019","unstructured":"Roden-Foreman JW, Rapier NR, Foreman ML, Zagel AL, Sexton KW, Beck WC, et al. Rethinking the definition of major trauma: the need for trauma intervention outperforms injury severity score and revised trauma score in 38 adult and pediatric trauma centers. J Trauma Acute Care Surg. 2019;87(3):658\u201365.","journal-title":"J Trauma Acute Care Surg"},{"issue":"3","key":"2985_CR16","doi-asserted-by":"publisher","first-page":"150","DOI":"10.1097\/JTN.0000000000000283","volume":"24","author":"JW Roden-Foreman","year":"2017","unstructured":"Roden-Foreman JW, Rapier NR, Yelverton L, Foreman ML. Asking a better question: development and evaluation of the need for trauma intervention (NFTI) metric as a novel indicator of major trauma. J Trauma Nurs. 2017;24(3):150\u20137.","journal-title":"J Trauma Nurs"},{"key":"2985_CR17","unstructured":"Japan Trauma Care and Research. Japan Trauma Data Bank Report 2022 (2019.1-2021.12). https:\/\/www.jtcr-jatec.org\/traumabank\/dataroom\/data\/JTDB2022.pdf (2022). Accessed June 2 2025."},{"key":"2985_CR18","doi-asserted-by":"publisher","first-page":"68","DOI":"10.1016\/j.jss.2024.12.008","volume":"306","author":"J Gorski","year":"2025","unstructured":"Gorski J, Goldstein S, Zeineddin S, Ramgopal S. An activation failure: factors associated with undertriage of pediatric major trauma victims. J Surg Res. 2025;306:68\u201376.","journal-title":"J Surg Res"},{"issue":"7","key":"2985_CR19","doi-asserted-by":"publisher","first-page":"671","DOI":"10.1001\/jamasurg.2018.1050","volume":"153","author":"R van der Sluijs","year":"2018","unstructured":"van der Sluijs R, van Rein EAJ, Wijnand JGJ, Leenen LPH, van Heijl M. Accuracy of pediatric trauma field triage: a systematic review. JAMA Surg. 2018;153(7):671\u20136.","journal-title":"JAMA Surg"},{"issue":"1","key":"2985_CR20","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1038\/s41598-022-09271-0","volume":"12","author":"H Kurosawa","year":"2022","unstructured":"Kurosawa H, Shiima Y, Miyakoshi C, Nezu M, Someya M, Yoshida M, et al. The association between prehospital vital signs of children and their critical clinical outcomes at hospitals. Sci Rep. 2022;12(1):1\u20137.","journal-title":"Sci Rep"},{"key":"2985_CR21","doi-asserted-by":"publisher","DOI":"10.1111\/acem.14837","author":"S Ramgopal","year":"2023","unstructured":"Ramgopal S, Horvat CM, Macy ML, Cash RE, Sepanski RJ, Martin-Gill C. Establishing outcome-driven vital signs ranges for children in the prehospital setting. Acad Emerg Med. 2023. https:\/\/doi.org\/10.1111\/acem.14837.","journal-title":"Acad Emerg Med"},{"issue":"4","key":"2985_CR22","doi-asserted-by":"publisher","first-page":"239","DOI":"10.1136\/emermed-2024-214402","volume":"42","author":"S Ramgopal","year":"2025","unstructured":"Ramgopal S, Crowe RP, Horvat CM, Macy ML, Cash RE, Sepanski RJ, et al. Prehospital vital sign abnormalities and in-hospital outcomes in children. Emerg Med J. 2025;42(4):239\u201340. https:\/\/doi.org\/10.1136\/emermed-2024-214402.","journal-title":"Emerg Med J"},{"issue":"4","key":"2985_CR23","doi-asserted-by":"publisher","first-page":"474","DOI":"10.1097\/ta.0000000000003727","volume":"93","author":"N Georgette","year":"2022","unstructured":"Georgette N, Keskey R, Hampton D, Alberto E, Chokshi N, Zakrison TL, et al. Derivation and validation of an improved pediatric shock index for predicting need for early intervention and outcomes in pediatric trauma. J Trauma Acute Care Surg. 2022;93(4):474\u201381. https:\/\/doi.org\/10.1097\/ta.0000000000003727.","journal-title":"J Trauma Acute Care Surg"},{"issue":"1","key":"2985_CR24","doi-asserted-by":"publisher","DOI":"10.1016\/j.injury.2024.111840","volume":"56","author":"S Ramgopal","year":"2025","unstructured":"Ramgopal S, Gorski JK, Chaudhari PP, Spurrier RG, Horvat CM, Macy ML, et al. Establishing thresholds for shock index in children to identify major trauma. Injury. 2025;56(1):111840.","journal-title":"Injury"}],"container-title":["European Journal of Trauma and Emergency Surgery"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s00068-025-02985-6.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/article\/10.1007\/s00068-025-02985-6","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s00068-025-02985-6.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,2,10]],"date-time":"2026-02-10T11:06:15Z","timestamp":1770721575000},"score":1,"resource":{"primary":{"URL":"https:\/\/link.springer.com\/10.1007\/s00068-025-02985-6"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,10,28]]},"references-count":24,"journal-issue":{"issue":"1","published-print":{"date-parts":[[2025,12]]}},"alternative-id":["2985"],"URL":"https:\/\/doi.org\/10.1007\/s00068-025-02985-6","relation":{},"ISSN":["1863-9933","1863-9941"],"issn-type":[{"value":"1863-9933","type":"print"},{"value":"1863-9941","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,10,28]]},"assertion":[{"value":"23 June 2025","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"20 September 2025","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"28 October 2025","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"Approved by the Yokohama City University Institutional Review Board (F230300003).","order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"This study was performed with a waiver of the requirement of informed consent by the Yokohama City University Institutional Review Board.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Consent to participate"}},{"value":"Not applicable.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Consent to publish"}},{"value":"The authors declare no competing interests.","order":4,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}},{"value":"Not applicable.","order":5,"name":"Ethics","group":{"name":"EthicsHeading","label":"Clinical trial number"}}],"article-number":"323"}}