Empirical Development and Evaluation of Prehospital Trauma Triage Instruments

Kane, Glenn; Engelhardt, Rita; Celentano, J. T.; Koenig, William; Yamanaka, Julie; Mckinney, Penny; Brewer, Marilynn B.; Fife, Daniel

doi:10.1097/00005373-198506000-00002

Cited by 87 publications

(32 citation statements)

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“…An ISS higher than 15 was used for inclusion because this has been shown to be associated with a greater need for specializedtraumacare. 14,15 Injury Severity Score and sex were also found to be statistically significant covariates in a previous study comparing urban and rural helicopter transport of patients with blunt trauma injuries. 16 The primary intervention was transport by either helicopter or ground EMS.…”

Section: Methodsmentioning

confidence: 78%

Association Between Helicopter vs Ground Emergency Medical Services and Survival for Adults With Major Trauma

Galvagno¹,

Haut²,

Zafar³

et al. 2013

Survey of Anesthesiology

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Context-Helicopter emergency medical services and their possible effect on outcomes for traumatically injured patients remain a subject of debate. Because helicopter services are a limited and expensive resource, a methodologically rigorous investigation of its effectiveness compared with ground emergency medical services is warranted.Objective-To assess the association between the use of helicopter vs ground services and survival among adults with serious traumatic injuries. Online-Only Material:The eFigure, eTables 1-3, and the Author Video Interview are available at http://www.jama.com.Author Contributions: Dr Galvagno had full access to all of the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis. Study concept and design: Galvagno, Haut, Millin, Efron, Koenig, Pronovost, Haider. Acquisition of data: Galvagno, Haut, Zafar, Haider. Analysis and interpretation of data: Galvagno, Zafar, Baker, Bowman, Haider. Drafting of the manuscript: Galvagno, Haut, Milllin, Efron, Baker, Bowman, Pronovost, Haider. Critical revision of the manuscript for important intellectual content: Galvagno, Koenig, Baker, Bowman, Pronovost, Haider. Statistical expertise: Galvagno, Zafar, Bowman, Haider.Administrative, technical, or material support: Galvagno, Haut, Efron, Pronovost, Haider. Study supervision: Galvagno, Haut, Haider. Conclusion-Among patients with major trauma admitted to level I or level II trauma centers, transport by helicopter compared with ground services was associated with improved survival to hospital discharge after controlling for multiple known confounders. NIH Public AccessTrauma remains the leading cause of death and disability among young people around the world. In the United States, more than 50 million people are injured per year, resulting in approximately 169 000 annual deaths and a lifetime cost of $406 billion. 1,2Over the past several years, significant improvements in survival after trauma have been achieved. One reason for this has been improvements in emergency medical services (EMS) and life-saving transport of trauma patients to a center capable of providing definitive care. The utility of helicopter EMS and its possible effect on outcomes for traumatically injured patients remains the subject of debate. [3][4][5][6][7][8] Because helicopter transport is a limited and expensive resource, a methodologically rigorous investigation of its effectiveness compared with ground EMS is warranted.Several studies have used the National Trauma Data Bank (NTDB) to assess outcomes for traumatically injured adultstransportedbyeitheroption. [9][10][11] Although each of these studies concluded that helicopter transport was associated with improved odds of survival, they also reported limitations to their conclusions because of the lack of testing for the assumptions of a regression model, and none was able to account for the differences in how patients were assigned treatments (helicopter or ground transport). Additionally, the high proportio...

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Section: Methodsmentioning

confidence: 78%

Association Between Helicopter vs Ground Emergency Medical Services and Survival for Adults With Major Trauma

Galvagno¹,

Haut²,

Zafar³

et al. 2013

Survey of Anesthesiology

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show abstract

“…This figure contrasts sharply with an estimate that hospital emergency department visits for injuries in 1977 totalled about 200 per 1000 (19). One Los Angeles County study that used a fairly restrictive measure of need for trauma center care estimated that only about 12% of the injury victims transported by ambulance should have been sent to trauma centers (27). By any standard, trauma centers are appropriate for only a small percentage of all injuries.…”

Section: Introductionmentioning

confidence: 90%

“…Of course, not all injury victims who use ambulance trans port need to go to a trauma center. For example, one study (27), which used an ISS score of 16 or more as the chief basis to (retrospectively) determine whether patients needed to go to a trauma center, found that only about 12%…”

Section: Who Should Be Served: Triage Criteriamentioning

confidence: 99%

“…For any given set of measures used in a triage protocol, the rate of overtriage can be reduced only by raising the rate of undertriage. Table 5, adapted from Kane et al (27), illustrates the trade-offs for a set of proposed triage rules by examining their impact on a sample of all patients transported by ambulance. The authors developed a checklist of indications for para medics to use to determine whether transport to a trauma center was needed.…”

Section: Who Should Be Served: Triage Criteriamentioning

confidence: 99%

See 1 more Smart Citation

Trauma Systems and Public Policy

Mendeloff

Cayten²

1991

Annu. Rev. Public Health

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“…Based on previous studies, these inclusion criteria will exclude some patients with serious injuries and/or requiring specialized trauma resources. 17,19,[21][22][23][24][25][26]29,30 However, using measures of physiologic derangement as inclusion criteria assures that a substantial portion of such patients will indeed have serious injury.…”

Section: Limitationsmentioning

confidence: 99%