Ineffectiveness of the trauma score and the CRAMS scale for accurately triaging patients to trauma centers

Ornato, Joseph P.; Mlinek, Edward J; Craren, Edward J.; Nelson, Norman M.

doi:10.1016/s0196-0644(85)80920-3

Cited by 75 publications

(18 citation statements)

References 6 publications

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“…The RTS and PHI remain among the best-known prehospital severity scores, 7,32 perhaps because alternatives are not convincingly superior. 33,34 We computed the PHI based on the original method of Koehler, 2 which yields a severity score from a formula based on the HR, SBP, "level of consciousness," "respiratory status," and whether or not there is penetrating thoraco-abdominal trauma. To ascertain if each casualty had penetrating thoraco-abdominal trauma, we employed an automated text search of the abbreviated injury scale fields in our database.…”

Section: Automatically-computed Severity Scoresmentioning

confidence: 99%

Automatically-Computed Prehospital Severity Scores are Equivalent to Scores Based on Medic Documentation

Reisner

Chen

McKenna

et al. 2008

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

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Methods:In a retrospective analysis of trauma casualties transported by air ambulance, we computed the Triage Revised Trauma Score (RTS) from archived travel monitor data. We compared the areas-under-the-curve (AUC's) of receiver operating characteristic curves for prediction of mortality and red blood cell transfusion for 187 subjects with comparable quantities of good-quality and poorquality data.Results: Vital signs deemed reliable by SQI's led to significantly more discriminatory severity scores than vital signs deemed unreliable. We also compared automatically-computed RTS (using the SQI's) versus RTS computed from vital signs documented by medics. For the subjects in whom the SQI algorithms identified 15 consecutive seconds of reliable vital signs data (n ‫؍‬ 350), the automaticallycomputed scores' AUC's were the same as the medic-based scores' AUC's. Using the Prehospital Index in place of RTS led to very similar results, corroborating our findings. Conclusions: SQI algorithms improveautomatically-computed severity scores, and automatically-computed scores using SQI's are equivalent to medic-based scores.

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Section: Automatically-computed Severity Scoresmentioning

confidence: 99%

Automatically-Computed Prehospital Severity Scores are Equivalent to Scores Based on Medic Documentation

Reisner

Chen

McKenna

et al. 2008

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

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“…2,12,14,17 Others found their ability to reliably identify overall injury severity a relatively poor indicator. 10,11,13,15,16 These conflicting findings may be partly caused by the variety of different outcome measures used to define injury severity across the studies. The studies also differed in terms of population (adult or pediatric), injury mechanism (blunt or penetrating), emergency medical service systems, and study size, potentially contributing to the conflicting findings.…”

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

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“…Previously described scoring systems and guidelines-for example, the prehospital Revised Trauma Score, Circulation, Respiration, Abdomen, Motor, Speech Scale and the American College of Surgeons triage decision scheme-are unable to reliably identify this patient group, and in this study only 26.7% of ambulance service responders acknowledged using a trauma scoring or coding system during alert calls to quantify injury severity. [3][4][5] A study of trauma alerting at a large English emergency department concluded that the majority of patients with major trauma (Injury Severity Score over 15) were not alerted by the ambulance service, and that 75% of patients alerted did not meet the Trauma Audit Research Network inclusion criteria for major trauma. 6 Trauma alert criteria, scoring systems and patient assessment schemes aim to identify all patients who will require immediate trauma team care.…”

Section: Discussionmentioning

confidence: 99%

A survey of trauma alert criteria and handover practice in England and Wales

Budd¹,

Almond

Porter

2007

Emergency Medicine Journal

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Introduction: Appropriate alerting of patients with trauma and informative handover are necessary to allow a smooth transition of care between the prehospital and hospital teams. Aim: To identify current practice and areas that need to be improved to facilitate the transition from prehospital care to emergency department resuscitation. Methods: A questionnaire postal study of 100 emergency departments and all 32 ambulance service trusts in England and Wales. Results: Emergency departments returned 34 (34%) completed questionnaires, and ambulance trusts returned 16 (50%) completed questionnaires. In all, 56.8% of emergency department responders stated that trauma alert information was relayed through ambulance control, 48.5% stated that alert messages were standardised and 18.5% felt that ambulance crews used the trauma severity scoring system during alerting. 64.7% stated that handover was broadcast to the trauma team and 9.1% routinely received digital photographic images. All ambulance service responders included injury mechanism in their alerting criteria and 53.3% used a standard handover structure with 86.7% familiar with the mnemonic ASHICE (Age, Sex, History, Injuries, Condition, Expected time of arrival) for rapid information transmission. Discussion: Greater cooperation between regional emergency departments and ambulance services is necessary to refine the alerting and handover process, producing a pathway through which vital information is collected by trained personnel and communicated without distortion to the resuscitation room, where it may be utilised to inform life-saving decisions.

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Ineffectiveness of the trauma score and the CRAMS scale for accurately triaging patients to trauma centers

Cited by 75 publications

References 6 publications

Automatically-Computed Prehospital Severity Scores are Equivalent to Scores Based on Medic Documentation

Automatically-Computed Prehospital Severity Scores are Equivalent to Scores Based on Medic Documentation

Prehospital Prediction of the Severity of Blunt Anatomic Injury

A survey of trauma alert criteria and handover practice in England and Wales

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