Enhancing Pediatric Emergency Triage and Analgesic Management: New Insights and Evolving Practices

ICASS demonstrates superior sensitivity for identifying children likely to require pediatric trauma-center resources, supporting a practice-ready shift in how undertriage is measured.

The metric links diagnostic coding to the likelihood of interventions such as transfusion, operative procedures, or ICU care, making it directly relevant to operational triage decisions. Using ICASS to define undertriage improves triage accuracy and reduces missed transfers of children who need higher-level resources.

ICASS differs from mortality-based measures such as ISS and ICISS by estimating the probability of resource utilization rather than the probability of death. Resource-focused metrics therefore prioritize sensitivity for intervention need and better reflect pediatric injury patterns—low mortality but nontrivial need for specialized care. This reframes assessment from predicting death to predicting treatment needs and highlights gaps in prior triage thresholds. In short, ICASS aligns benchmarks with the services children actually require.

This analysis used a large registry-based observational design to compare ISS, ICISS, and ICASS against a predefined need-for-pediatric-trauma-center-resources (NFPTCR) endpoint that included early transfusion, urgent operative or invasive procedures, ICU admission or prolonged ICU stay, mechanical ventilation in young children, and other resource-driven criteria. Among 97,773 children, 15,985 (16%) met NFPTCR criteria. ICASS achieved the highest discrimination (AUC 0.812) compared with ISS (AUC 0.760) and ICISS (AUC 0.701), and it demonstrated markedly greater sensitivity across practical thresholds (for example, ICASS >5 yielded >95% sensitivity for NFPTCR). These findings support reorienting triage evaluation toward resource-focused outcomes.

Accurate triage also supports appropriate analgesic access. When triage better matches resource needs, analgesic stewardship at the point of care becomes more reliable. Together, these practices emphasize safety and stewardship in pediatric emergency analgesic prescribing.

Key Takeaways:

• ICASS is a resource-focused metric that more sensitively identifies children who will use trauma-center resources.
• Pediatric trauma systems, prehospital triage protocols, and clinicians making interfacility-transfer and activation decisions.
• Implement ICASS-based retrospective audits, adjust triage thresholds to balance undertriage and overtriage, and monitor outcomes after metric adoption.