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J Trauma. 2010 Feb;68(2):452-62. doi: 10.1097/TA.0b013e3181ae20c9.

A critical assessment of the out-of-hospital trauma triage guidelines for physiologic abnormality.

Collaborators (331)

Kerby JD, Brown TB, Terndrup T, Stephens SW, Williams CR, Acker JE, Minor ML, MacLennan PA, Pritchard PR, Caldwell S, Lai KR, Idris AH, Benitez F, Fowler R, Lemecha D, Minei J, Pepe P, Ramsay M, Simonson R, Wigginton J, Climer D, Moffat M, Newman K, Owens P, Bennett A, Black R, Cason D, Craft B, Detamble L, Dykes R, Harvey T, Hewitt S, Isaacs M, Kay J, Kayea T, LaChance R, Lehman T, Mayer P, Metzger J, Miller D, Navarro K, Parker S, Pickard K, Porter W, Starling TJ, Tine T, Vinson C, Abebefe D, Arze S, Black S, Bush M, Forman M, Goodloe J, Kelly R, Lachar G, Mangram A, Morales M, Thornton E, Wiebe R, Kerber R, Hata S, Atkins D, Kenney M, Rost C, Drum A, Hartley M, Aufderheide TP, Pirrallo RG, Brasel KJ, Winthrop AL, Klein JP, Kitscha DJ, Burja BJ, von Briesen C, Sparks CW, Kaebisch S, Chianelli J, Forster R, Milbrath M, Pukansky L, Sternig K, Chin E, Frieberg N, Krueger K, Szewczuga D, Duerr T, Funk R, Jacobsen G, Spitzer J, Demien R, Martins J, Cohn J, Spahn RR, Jankowski M, James T, Wentlandt WE Jr, Berousek D, Satula BM, Behling JB, Redman DK, Hook S, Neargarder A, Singer J, Reminga T, Shepherd D, Holzhauer P, Rubin J, Skold C, Alvarez O, Harkins H, Barthell E, Haselow W, Yee A, Whitcomb J, Castro EE, Motarjeme S, Stiell I, Christenson J, Hameed M, Yelle JD, Osmond M, Vaillancourt C, Evans D, Abu-Laban R, Clement C, Beaudoin T, Boychuk B, Pennington S, Connolly H, Lefaivre P, Banek J, Marcantonio A, Marcantonio R, Leclair C, Cummins J, Stempien M, Dreyer J, Munkley D, Maloney J, Colella P, Affleck A, Waldbillig D, Bradford P, Lees M, Arcieri V, Wilson A, Boyle K, Luinstra-Toohey L, Trickett J, Sykes N, Graham E, Ballah K, Hedges C, Mathers P, Andrusiek D, Bishop D, Straight R, Twaites B, Donn S, Callaway C, Tisherman S, Rittenberger J, Hostler D, Condle J, Kampmeyer M, Markham T, Morgan M, Sabol P, Sicchitano G, Sherry S, Shrader A, Stull G, Torres M, Groft W, McCaughan R, Rohrer R, Cole J, Fuchs D, Guyette F, Jenkins W, Roth R, Walker H, Corcos A, Doshi A, Ong A, Peitzman A, Hedges JR, Newgard CD, Daya MR, Lowe RA, Griffiths D, Brett J, Zive D, Yekrang A, Nakamura Y, Frakes B, Monnig A, Jui J, Schmidt TA, Sahni R, Warden CR, Muhr MD, Stouffer JA, Gorman K, Rosteck P, Koenig K, Lee J, Barnes R, Tucker H, Allen B, Bishop TJ, Glaser A, Schreiber MA, Anderson J, Ramzy AI, Gubler KD, Wittwer LK, Underwood S, Barone B, Haun-Taylor D, Bryant E, Miller J, Hoyt D, Coimbra R, Vilke G, Kelly D, McCallum-Brown L, Haynes B, Schwartz B, Size M, Kennedy F, Simon F, Tominaga G, Steele J, Kudenchuk PJ, Rea TD, Bulger E, Eisenberg MS, Copass M, Olsufka M, Ragsdale S, Solberg D, Damon S, Phelps R, O'Brien J, Sodeman E, LaFave M, Boehl J, Jones D, Somers G, Ayrs D, Whorton A, Warren S, Fogarty J, Larsen J, Helbock M, Slutsky A, Morrison L, Dorian P, Beers C, Bigham B, Braga D, Burgess G, Cameron B, Chung S, De Maio P, Driscoll S, Fell L, Frank J, McLennan M, Molyneaux LA, Ryan W, Schotsman A, Simonini J, Turcotte L, Veel F, Wassenaar A, Zahn C, Bradshaw D, Burgess R, Cameron B, Chad S, Cheskes S, Craig A, Dewar S, Dodd T, Duquette R, Epp M, Feldman M, Jones V, MacDonald R, MacKay L, McNenley S, Moore J, Moran P, Murray M, Nemeth M, Olnyk R, Perreira T, Renaud R, Roche K, Shield J, Silver D, Stevens J, Verbeek R, Waite T, Webb K, Welsford M, Farrell R, Hutchison J, Weisfeldt M, Ornato JP, Hoyt DB, Holcomb JB, Hoke T, Sopko G, Lathrop D, Mascette A, Nickens PD, Hallstrom A, Nichol G, Emerson S, Powell J, Sears G, Bardarson B, Van Ottingham L, Leonen A, Ledingham RB, Finley C, Moore R, Bergsten-Buret B.

Author information

1
Department of Emergency Medicine, Center for Policy and Research in Emergency Medicine, Oregon Health and Science University, Portland, Oregon, USA. newgardc@ohsu.edu

Abstract

BACKGROUND:

It remains unclear whether the American College of Surgeons Committee on Trauma (ACSCOT) "step 1" field physiologic criteria could be further restricted without substantially sacrificing sensitivity. We assessed whether more restrictive physiologic criteria would improve the specificity of this triage step without missing high-risk patients.

METHODS:

We analyzed an out-of-hospital, consecutive patient, prospective cohort of injured adults >or=15 years collected from December 1, 2005, to February 28, 2007, by 237 emergency medical service agencies transporting to 207 acute care hospitals in 11 sites across the United States and Canada. Patients were included based on ACSCOT field decision scheme physiologic criteria systolic blood pressure <or=90, respiratory rate <10 or >29 breaths/min, Glasgow Coma Scale score <or=12, or field intubation. Seven field physiologic variables and four additional demographic and mechanism variables were included in the analysis. The composite outcome was mortality (field or in-hospital) or hospital length of stay >2 days.

RESULTS:

Of 7,127 injured persons, 6,259 had complete outcome information and were included in the analysis. There were 3,631 (58.0%) persons with death or LOS >2 days. Using only physiologic measures, the derived rule included advanced airway intervention, shock index >1.4, Glasgow Coma Scale <11, and pulse oximetry <93%. Rule validation demonstrated sensitivity 72% (95% confidence interval: 70%-74%) and specificity 69% (95% confidence interval: 67%-72%). Inclusion of demographic and mechanism variables did not significantly improve performance measures.

CONCLUSIONS:

We were unable to omit or further restrict any ACSCOT step 1 physiologic measures in a decision rule practical for field use without missing high-risk trauma patients.

PMID:
20154558
PMCID:
PMC3785297
DOI:
10.1097/TA.0b013e3181ae20c9
[Indexed for MEDLINE]
Free PMC Article

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