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Open Access 01-12-2023 | Emergency Medicine | Research

Systemic review of age brackets in pediatric emergency medicine literature and the development of a universal age classification for pediatric emergency patients - the Munich Age Classification System (MACS)

Authors: Alexander Althammer, Stephan Prückner, Geogr Christian Gehring, Victoria Lieftüchter, Heiko Trentzsch, Florian Hoffmann

Published in: BMC Emergency Medicine | Issue 1/2023

Abstract

Currently arbitrary, inconsistent and non-evidence-based age cutoffs are used in the literature to classify pediatric emergencies. None of these classifications have valid medical rationale. This leads to confusion and poor comparability of the different study results. To clarify this problem, this paper presents a systematic review of the commonly used age limits from 115 relevant articles. In the literature search 6226 articles were screened. To be included, the articles had to address the following three topics: “health services research in emergency medicine”, “pediatrics” and “age as a differentiator”. Physiologic and anatomic principles with reference to emergency medicine were used to solve the problem to create a medically based age classification for the first time.

The Munich Age Classification System (MACS) presented in this paper is thus consistent with previous literature and is based on medical evidence. In the future, MAC should lead to ensure that a uniform classification is used. This will allow a better comparability of study results and enable meta-analyses across studies.

Dobson JV, Bryce L, Glaeser PW, Losek JD. Age limits and transition of health care in pediatric emergency medicine. Pediatr Emerg Care. 2007;23(5):294–7. https://doi.org/10.1097/01.pec.0000248701.87916.05.CrossRefPubMed

Williams K, Thomson D, Seto I, Contopoulos-Ioannidis DG, Ioannidis JPA, Curtis S, Constantin E, Batmanabane G, Hartling L, Klassen T. Standard 6: age groups for pediatric trials. Pediatr 129 Suppl. 2012;3153–60. https://doi.org/10.1542/peds.2012-0055I.

Clark R, Locke M, Bialocerkowski A. Paediatric terminology in the australian health and health-education context: a systematic review. Dev Med Child Neurol. 2015;57(11):1011–8. https://doi.org/10.1111/dmcn.12803.CrossRefPubMed

Job KM, Gamalo M, Ward RM. Pediatric Age Groups and Approach to Studies. Therapeutic Innov Regul Sci. 2019;53(5):584–9. https://doi.org/10.1177/2168479019856572.CrossRef

Moher D, Liberati A, Tetzlaff J, Altman DG. Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. PLoS Med. 2009;6(7):e1000097. https://doi.org/10.1371/journal.pmed.1000097.CrossRefPubMedPubMedCentral

Miller SA, Forrest JL. Enhancing your practice through evidence-based decision making: PICO, learning how to ask good questions. J Evid Based Dent Pract. 2001;1(2):136–41. https://doi.org/10.1016/S1532-3382(01)70024-3.CrossRef

Kassenärztliche B. (2020) 4.3.5 - Altersgruppen. https://www.kbv.de/tools/ebm/html/4.3.5_162395004446927562274884.html. Accessed 17 Sep 2020.

Emr BM, Alcamo AM, Carcillo JA, Aneja RK, Mollen KP. Pediatric Sepsis Update: how are children different? Surg Infect. 2018;19(2):176–83. https://doi.org/10.1089/sur.2017.316.CrossRef

Ishimine P. Fever without source in children 0 to 36 months of age. Pediatr Clin North Am. 2006;53(2):167–94. https://doi.org/10.1016/j.pcl.2005.09.012.CrossRefPubMed

10.

Hoffmann F, Nicolai T. Algorithmus zum Vorgehen bei häufigen respiratorischen Notfällen im Kindesalter. Notfall Rettungsmed. 2009;12(8):576–82. https://doi.org/10.1007/s10049-009-1197-y.CrossRef

11.

TBI-related Deaths | Concussion | Traumatic Brain Injury | CDC Injury Center. (2020). https://www.cdc.gov/traumaticbraininjury/data/tbi-deaths.html. Accessed 18 Aug 2020.

12.

Rickels E, von Wild K, Wenzlaff P. Head injury in Germany: a population-based prospective study on epidemiology, causes, treatment and outcome of all degrees of head-injury severity in two distinct areas. Brain Injury. 2010;24(12):1491–504. https://doi.org/10.3109/02699052.2010.498006.CrossRefPubMed

13.

Jöhr M. (2019) Kinderanästhesie, 9. Auflage.

14.

Ygberg S, Nilsson A. (2012) The developing immune system - from foetus to toddler. Acta paediatrica (Oslo, Norway: 1992) 101(2):120–127. doi: https://doi.org/10.1111/j.1651-2227.2011.02494.x.

15.

Walker JC, Smolders MAJC, Gemen EFA, Antonius TAJ, Leuvenink J, de Vries E. Development of lymphocyte subpopulations in preterm infants. Scand J Immunol. 2011;73(1):53–8. https://doi.org/10.1111/j.1365-3083.2010.02473.x.CrossRefPubMed

16.

Burri PH. Structural aspects of postnatal lung development - alveolar formation and growth. Biol Neonate. 2006;89(4):313–22. https://doi.org/10.1159/000092868.CrossRefPubMed

17.

Leidel BA, Peiser C, Wolf S, Kanz K-G. Kleiner Sturz, großer Schaden? (emergency department management of mild traumatic brain injury in children - an evidencebased algorithmic approach). MMW Fortschr der Medizin. 2016;158(8):56–9. https://doi.org/10.1007/s15006-016-8149-0.CrossRef

18.

DiBrito SR, Cerullo M, Goldstein SD, Ziegfeld S, Stewart D, Nasr IW. Reliability of Glasgow Coma score in pediatric trauma patients. J Pediatr Surg. 2018;53(9):1789–94. https://doi.org/10.1016/j.jpedsurg.2017.12.027.CrossRefPubMed

19.

Zimmer A, Reith W. Schädel-Hirn-Trauma bei Kindern (Head injuries in children). Radiologe. 2009;49(10):918–25. https://doi.org/10.1007/s00117-009-1838-7.CrossRefPubMed

20.

Laurer H, Wutzler S, Wyen H, Westhoff J, Lehnert M, Lefering R, Marzi I. Prä- und frühklinische Versorgungsqualität pädiatrischer Traumapatienten im Schulalter im Vergleich mit dem Erwachsenenkollektiv. Matched-pair-analyse an 624 Patienten aus dem Traumaregister der DGU (Quality of prehospital and early clinical care of pediatric trauma patients of school age compared to an adult cohort. A matched-pair analysis of 624 patients from the DGU trauma registry). Der Unfallchirurg. 2009;112(9):771–7. https://doi.org/10.1007/s00113-009-1589-y.CrossRefPubMed

21.

Dennis M. Margaret Kennard (1899–1975. Cortex. 2010;46(8):1043–59. https://doi.org/10.1016/j.cortex.2009.10.008. not a ‘principle’ of brain plasticity but a founding mother of developmental neuropsychology.

22.

Growth Charts - Data Table of Infant Weight-for-age Charts. (2023). https://www.cdc.gov/growthcharts/html_charts/wtageinf.htm. Accessed 28 Apr 2023.

Title: Systemic review of age brackets in pediatric emergency medicine literature and the development of a universal age classification for pediatric emergency patients - the Munich Age Classification System (MACS)
Authors: Alexander Althammer
Stephan Prückner
Geogr Christian Gehring
Victoria Lieftüchter
Heiko Trentzsch
Florian Hoffmann
Publication date: 01-12-2023
Publisher: BioMed Central
Keyword: Emergency Medicine
Published in: BMC Emergency Medicine / Issue 1/2023
Electronic ISSN: 1471-227X
DOI: https://doi.org/10.1186/s12873-023-00851-5

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Systemic review of age brackets in pediatric emergency medicine literature and the development of a universal age classification for pediatric emergency patients - the Munich Age Classification System (MACS)

Abstract

Keynote webinar | Spotlight on medication adherence

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