Applying the Trauma Triage Rule to Blunt Trauma Patients

Mechanic, Andrew D.; Hedges, J. R.; Sparkman, Kent; Jui, Jon; Mullins, Richard J.

doi:10.1111/j.1553-2712.1995.tb03148.x

Cited by 22 publications

(5 citation statements)

References 23 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…22 Similarly different definitions of ICU admission 12,17 and urgent surgery were applied, where urgent surgery has been shown to exclude a number of patients in comparable studies. 3 Applying the range of criteria (ISS Ͼ15, ICU Ͼ24 hours, urgent surgery, and death) in this study, captured patients who required the specialist services provided by a MTS. The fact that the three patients under-triaged were identified on the basis of an ISS may indicate a problem with the score rather than paramedic judgment.…”

Section: Discussionmentioning

confidence: 99%

“…It is generally straightforward to identify criteria based on physiologic abnormalities or mechanism of injury. 3 Mechanistic indicators are potentially useful in identifying at risk patients, but result in over-triage. 4,5 Anatomic indicators have demonstrated improvement in triage performance; 6 -8 however the identification of blunt anatomic injuries in the prehospital setting is difficult, 6,9 where clinical assessment is limited in determining the extent of internal organ damage.…”

mentioning

confidence: 99%

See 1 more Smart Citation

Prehospital Prediction of the Severity of Blunt Anatomic Injury

Mulholland

Cameron

Gabbe

et al. 2008

Journal of Trauma: Injury, Infection &Amp; Critical Care

View full text Add to dashboard Cite

show abstract

Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

Prehospital Prediction of the Severity of Blunt Anatomic Injury

Mulholland

Cameron

Gabbe

et al. 2008

Journal of Trauma: Injury, Infection &Amp; Critical Care

View full text Add to dashboard Cite

show abstract

“…We defined early critical resource use as a composite measure of any of the following variables within 24 hours of ED arrival: emergent intubation in the ED, major nonorthopedic surgical intervention [brain, spine, neck, thorax, abdominal-pelvic, or vascular surgery], interventional radiologic procedures, packed red blood cell transfusion of 6 U or more in an adult, or any blood transfusion in a child, or death. This definition was based on previous trauma triage research, a national consensus study defining trauma center need, and a 5-member advisory committee of content experts (including two of us, J.R.H. and N.C.M.)…”

Section: Methodsmentioning

confidence: 99%

Evaluation of Rural vs Urban Trauma Patients Served by 9-1-1 Emergency Medical Services

Newgard

Bulger

et al. 2017

JAMA Surg

View full text Add to dashboard Cite

Importance Despite a large rural US population, there are potential differences between rural and urban regions in the processes and outcomes following trauma. Objectives To describe and evaluate rural vs urban processes of care, injury severity, and mortality among injured patients served by 9-1-1 emergency medical services (EMS). Design, Setting, and Participants This was a preplanned secondary analysis of a prospective cohort enrolled from January 1 through December 31, 2011, and followed up through hospitalization. The study included 44 EMS agencies transporting to 28 hospitals in 2 rural and 5 urban counties in Oregon and Washington. A population-based, consecutive sample of 67047 injured children and adults served by EMS (1971 rural and 65 076 urban) was enrolled. Among the 53 487 patients transported by EMS, a stratified probability sample of 17 633 patients (1438 rural and 16 195 urban) was created to track hospital outcomes (78.9% with in-hospital follow-up). Data analysis was performed from June 12, 2015, to May 20, 2016. Exposures Rural was defined at the county level by 60 minutes or more driving proximity to the nearest level I or II trauma center and/or rural designation in the Centers for Medicare & Medicaid Services ambulance fee schedule by zip code. Main outcomes and Measures Mortality (out-of-hospital and in-hospital), need for early critical resources, and transfer rates. Results Of the 53 487 injured patients transported by EMS (17 633 patients in the probability sample), 27 535 were women (51.5%); mean (SD) age was 51.6 (26.1) years. Rural vs urban sensitivity of field triage for identifying patients requiring early critical resources was 65.2% vs 80.5%, and only 29.4% of rural patients needing critical resources were initially transported to major trauma centers vs 88.7% of urban patients. After accounting for transfers, 39.8% of rural patients requiring critical resources were cared for in major trauma centers vs 88.7% of urban patients. Overall mortality did not differ between rural and urban regions (1.44% vs 0.89%; P = .09); however, 89.6% of rural deaths occurred within 24 hours compared with 64% of urban deaths. Rural regions had higher transfer rates (3.2% vs 2.7%) and longer transfer distances (median, 97.4 km; interquartile range [IQR], 51.7-394.5 km; range, 47.8-398.6 km vs 22.5 km; IQR, 11.6-24.6 km; range, 3.5-97.4 km). Conclusions and Relevance Most high-risk trauma patients injured in rural areas were cared for outside of major trauma centers and most rural trauma deaths occurred early, although overall mortality did not differ between regions. There are opportunities for improved timeliness and access to major trauma care among patients injured in rural regions.

show abstract

“…However, a study evaluating the Baxt Trauma Triage Rule retrospectively, reported lower sensitivities and specificity. 42 …”

Section: Trauma Triage Rulementioning

confidence: 97%