Details:

Alternative Title:
J Am Coll Surg
Publisher's site:
http://dx.doi.org/10.1016/j.jamcollsurg.2015.10.016
Personal Author:
Newgard, Craig D ; Fu, Rongwei ; Zive, Dana ; Rea, Tom ; Malveau, Susan ; ... More +
Newgard, Craig D ; Fu, Rongwei ; Zive, Dana ; Rea, Tom ; Malveau, Susan ; Daya, Mohamud ; Jui, Jonathan ; Griffiths, Denise E ; Wittwer, Lynn ; Sahni, Ritu ; Gubler, K Dean ; Chin, Jonathan ; Klotz, Pat ; Somerville, Stephanie ; Beeler, Tina ; Bishop, TJ ; Garland, Tara N ; Bulger, Eileen Less -
Description:
BACKGROUND

The national field trauma triage guidelines have been widely implemented in US trauma systems, but never prospectively validated. We sought to prospectively validate the guidelines, as applied by out-of-hospital providers, for identifying high-risk trauma patients.

STUDY DESIGN

This was an out-of-hospital prospective cohort study from January 1, 2011 through December 31, 2011 with 44 Emergency Medical Services agencies in 7 counties in 2 states. We enrolled injured patients transported to 28 acute care hospitals, including 7 major trauma centers (Level I and II trauma hospitals) and 21 nontrauma hospitals. The primary exposure term was Emergency Medical Services’ use of one or more field triage criteria in the national field triage guidelines. Outcomes included Injured Severity Score ≥16 (primary) and critical resource use within 24 hours of emergency department arrival (secondary).

RESULTS

We enrolled 53,487 injured children and adults transported by Emergency Medical Services to an acute care hospital, 17,633 of which were sampled for the primary analysis; 13.9% met field triage guidelines, 3.1% had Injury Severity Score ≥16, and 1.7% required early critical resources. The sensitivity and specificity of the field triage guidelines were 66.2% (95% CI, 60.2–71.7%) and 87.8% (95% CI, 87.7–88.0%) for Injury Severity Score ≥16 and 80.1% (95% CI, 65.8–89.4%) and 87.3% (95% CI 87.1–87.4%) for early critical resource use. Triage guideline sensitivity decreased with age, from 87.4% in children to 51.8% in older adults.

CONCLUSIONS

The national field triage guidelines are relatively insensitive for identifying seriously injured patients and patients requiring early critical interventions, particularly among older adults.


Subject:
[+]
Adolescent
Adult
Article
Child
Child, Preschool
Critical Care
Emergency Service, Hospital
Female
Hospitalization
Humans
Infant
Infant, Newborn
Injury Severity Score
Male
Middle Aged
Practice Guidelines As Topic
Prospective Studies
Reproducibility Of Results
Sensitivity And Specificity
Triage
Wounds And Injuries
Young Adult

Source:
J Am Coll Surg. 222(2):146-58.e2.
Pubmed ID:
26712244
Pubmed Central ID:
PMC5323436
Document Type:
Journal Article
Funding:
R01 CE001837/CE/NCIPC CDC HHS/United States ; R01CE001837/CE/NCIPC CDC HHS/United States
R01 CE001837/CE/NCIPC CDC HHS/United States ; R01CE001837/CE/NCIPC CDC HHS/United States Less -
Collection(s):
CDC Public Access
Main Document Checksum:
[+]
urn:sha256:758db2c21055f8d7286dcf9c25bfb465532ae99441455ffcd50f1c097990b94f
File Type:

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