Accuracy of the Prehospital Index in Identifying Major Hemorrhage in Trauma Victims

Abstract

Purpose:To determine the sensitivity of the Prehospital Index (PHI) in identifying patients with severe blood loss, a one-year review was conducted at a regional trauma facility.Methods:The study population consisted of 217 consecutive trauma admissions (ages 3 to 88 years). Patients were managed using standard resuscitation techniques; blood transfusions were ordered at the discretion of attending physicians and did not follow any preplanned protocol. Medical records were examined to determine total blood requiremets for each patient during the first 12 hours of hospitalization, the emergency department (ED) disposition, and final outcome of treatment. The following clinical variables were analyzed (unpaired t-test) to determine their value as predictors of blood loss: age, gender, mechanism of injury, initial vital signs, revised trauma score, PHI, and injury severityscore.Results:Forty-two percent (92 patients) received transfusions during the first 12 hours of hospitalization. The best predictor of blood loss was the Prehospital Index. Of the total group, 45% had a PHI >3; 77% (75/98) of these patients required transfusion and received an average of 7.1 units of packed cells. Fifty-five percent (119/217) had a PHI ≤3; 86% (102/119) of these patients did not require transfusion.Conclusion:The data suggest that patients with PHI scores >3 require close hemodynamic monitoring to rule out significant blood loss and may warrant immediate cross-matching on arrival to the ED.

Early Predictors of Transfusion and Mortality After Injury: A Review of the Data-Based Literature

“…10 Similarly, Jones demonstrated, in a study population of 217 patients, that a pre-hospital index score Ͼ3 was associated with a 77% chance of requiring red cell therapy and, among those with a pre-hospital index score Յ3, only 14% required transfusion. 11 In a series published in 2002 by Starr and colleagues, the revised trauma score showed a significant correlation with the requirement for blood transfusion after traumatic injury and pelvic fracture. 12 Given the complexity of some of the pre-hospital trauma scoring systems, Franklin and colleagues evaluated pre-hospital hypotension as a surrogate for pre-hospital scoring and found that nearly 50% of patients with survivable pre-hospital hypotension required specific therapy for hemorrhage.…”

Evaluation of the Prehospital Index, presence of high-velocity impact and judgment of emergency medical technicians as criteria for trauma triage

“…So far, few studies have used full prehospital data sets to evaluate triage criteria. 13,15,18,25,27,33 Other studies have relied either exclusively on trauma registry data 8,11,14,16,19,34 or on sampling strategies that overrepresent major trauma in their cohorts. 12,17 This would explain why their rates of overtriage were lower than those observed in this study as many false-positive cases are thus excluded from the cohort.…”

“…The PHI has been the object of several validation studies. [12][13][14][15][16][17] The evaluation of HVI presence is intended to identify injuries involving a high level of energy transfer. Specific examples include a fall greater than 7 m (20 ft), another victim killed in the same accident, ejection from a motor vehicle, cabin structural intrusion and pedestrian or cyclist hit by a motor vehicle travelling faster than 8 km/h (5 mile/h).…”