Does Mechanism of Injury Predict Trauma Center Need?

Abstract

Objective To determine the predictive value of the Mechanism of Injury step of the American College of Surgeon’s Field Triage Decision Scheme for determining trauma center need. Methods EMS providers caring for injured adult patients transported to the regional trauma center in 3 midsized communities over two years were interviewed upon ED arrival. Included was any injured patient, regardless of injury severity. The interview collected patient physiologic condition, apparent anatomic injury, and mechanism of injury. Using the 1999 Scheme, patients who met the physiologic or anatomic steps were excluded. Patients were considered to need a trauma center if they had non-orthopedic surgery within 24 hours, intensive care unit admission, or died prior to hospital discharge. Data were analyzed by calculating positive likelihood ratios (+LR) and 95% confidence intervals (CI) for each mechanism of injury criteria. Results 11,892 provider interviews were conducted. Of those, 1was excluded because outcome data were not available and 2,408 were excluded because they met the other steps of the Field Triage Decision Scheme. Of the remaining 9,483 cases, 2,363 met one of the mechanism of injury criteria, 204 (9%) of which needed the resources of a trauma center. Criteria with a +LR ≥5 were death of another occupant in the same vehicle (6.8; CI:2.7–16.7), fall >20 ft.(5.2; CI:2.4–11.3), and motor vehicle crash (MVC) extrication >20 minutes (5.0; CI:3.2–8.0). Criteria with a +LR between 2 and <5 were intrusion >12 inches (3.7; CI:2.6–5.3), ejection (3.2; CI:1.3–8.2), and deformity >20 inches (2.3; CI:1.7–3.0). The criteria with a +LR <2 were MVC speed >40 mph (1.9; CI:1.5–2.2), pedestrian/bicyclist struck >5mph (1.2; CI:1.0–1.5), bicyclist/pedestrian thrown or run over (1.2; CI:0.9–1.6), motorcycle crash >20mph (1.1; CI:0.96–1.3), rider separated from motorcycle (1.0; CI:0.9–1.2), and MVC rollover (1.0; CI:0.7–1.5). Conclusion Death of another occupant, fall distance, and extrication time were good predictors of trauma center need when a patient did not meet the anatomic or physiologic conditions. Intrusion, ejection, and vehicle deformity were moderate predictors.

Relação entre o mecanismo de trauma e lesões diagnosticadas em vítimas de trauma fechado

“…Ideally, each trauma victim is assessed according to severity already on the scene, by criteria such as ISS greater than 15, need for intensive treatment and / or non-orthopedic surgery. These cases, considered severe, are then referred to the level 1 trauma center (of greater complexity in the American system), reducing supertriage and, consequently, the overcrowding of hospitals and the costs of care 9 . The frequency of trauma mechanisms depends on the region in which they are analyzed.…”

“…Several studies have evaluated specific characteristics, even in a prehospital environment, that lead us to observe it 8,9 . The analysis of the trauma mechanism is very important for all professionals responsible for these cases, and is already considered in the initial care standardized by the Advanced Trauma Life Support course 10 .…”

Extrication time prediction tool

“…There may be an association between the vehicle being on its roof and an increased severity of injuries8—this may encourage crews to work quicker to extricate the patient. Further review of these cases is planned to determine why extrication time was quicker in this subgroup of extrications.…”

Motor Vehicle Crash Severity Estimations by Physicians and Prehospital Personnel

“…Crash mechanism, including speed, location of impact, and passenger compartment damage, provides insight into the patient’s potential for serious injury. 10 Since we know EPs modify their evaluation of MVC victims when provided with a crash scene photograph in addition to verbal or written reports, it may be implied that differences in crash severity estimations influence subsequent ED care. 11 Presumably, a more accurate representation of crash severity and mechanism will improve the EP’s ability to care for patients.…”

“…9 In addition, the presence of crash photographs significantly alters the physician’s perception of crash severity and subsequent management, and physicians are likely to rate the crash as more severe than the verbal report indicated. 10 …”