“Insignificant” Mechanism of Injury: Not To Be Taken Lightly

Velmahos, George C.; Jindal, Anurag; Chan, Linda S.; Murray, James A.; Vassiliu, Pantelis; Berne, Thomas V.; Asensio, Juan A.; Δημητριάδης, Δημήτριος

doi:10.1016/s1072-7515(00)00790-0

Cited by 55 publications

(33 citation statements)

References 9 publications

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“…The Advanced Trauma Life Support (ATLS) triage guidelines suggest transfer to a trauma center of patients ‡ 55 years of age with evidence of high-energy impact [9], even though in this age group high incidence rates of severe injuries after only a minor trauma have been reported [10][11][12]. Additionally, Philips et al [13] illustrated that the severity of injury and physiologic disturbance in the elderly is often underestimated.…”

Section: Introductionmentioning

confidence: 99%

The Value of the Trauma Mechanism in the Triage of Severely Injured Elderly

Nijboer

Sluis

Dijkstra

et al. 2008

Eur J Trauma Emerg Surg

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The value of the trauma mechanism in the triage of severely injured elderly Nijboer, J.M.M.; van der Sluis, Corry K.; Dijkstra, Pieter U. ; ten Duis, H.J. Take-down policy If you believe that this document breaches copyright please contact us providing details, and we will remove access to the work immediately and investigate your claim.Downloaded from the University of Groningen/UMCG research database (Pure): http://www.rug.nl/research/portal. For technical reasons the number of authors shown on this cover page is limited to 10 maximum. Abstract Background: The triage of trauma patients is currently based on the trauma mechanism. However, it is known that elderly patients can sustain severe injuries due to insignificant trauma mechanisms. As such, triage methods might be questionable. Objective: To evaluate whether current trauma triage criteria are appropriate in severely injured elderly patients. Methods: To analyze the effect of the trauma mechanism on triage and treatment, consecutive patients ‡ 55 years of age, with an injury severity score > 15, treated from 2002 to 2005 were divided into those who sustained a high-energy trauma (HET) versus a low energy trauma (LET). Pre-hospital and in-hospital data, injury characteristics, and data on mortality and disablement one year postinjury (sickness impact profile) were analyzed for HET and LET groups. Results: Age, sex and co-morbidity rate were similar in 84 HET patients and 107 LET patients. HET patients (mean ISS 28) received more sophisticated trauma care than LET patients (mean ISS 22), although mortality was similar (38 vs. 34%). Long-term disablement was also similar (median SIP scores 4 vs. 6). Severe head injuries and the Revised Trauma Score were related to mortality. Physical disablement was related to preexisting co-morbidities. No variables were related to psychosocial disablement. Conclusions: In elderly people a low energy trauma may lead to severe consequences. Not only the trauma mechanism, but also age, co-morbidity, and the likelihood of a brain injury should be leading in the triage and subsequent management of severely injured elderly.

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Section: Introductionmentioning

confidence: 99%

The Value of the Trauma Mechanism in the Triage of Severely Injured Elderly

Nijboer

Sluis

Dijkstra

et al. 2008

Eur J Trauma Emerg Surg

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“…These patients had a mean age of 47.2 (±26.4) years and a mean ISS of 20.9 (±4.6; range [16][17][18][19][20][21][22][23][24][25][26][27][28][29]. Almost two-third of these false negatives incurred extremity (66.7%) injuries, whereas only 39.6% of the other major trauma patients, the true positives, sustained extremity injuries (p=0.068).…”

Section: Resultsmentioning

confidence: 99%

“…Previous studies have also questioned the significance of the mechanistic criteria because these are prone to false positives [21][22][23][24]. For example, people involved in severe car crashes may be uninjured.…”

Section: Discussionmentioning

confidence: 99%

Prehospital identification of major trauma patients

Ocak

Sturms

Hoogeveen

et al. 2008

Langenbecks Arch Surg

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Background and aims Prehospital triage is aimed at getting the right patient to the right hospital. Evaluations on the performance of prehospital triage tools are scarce. This study examines the ability of the American College of Surgeons' Committee on Trauma (ACSCOT) triage guidelines to identify major trauma patients in a European trauma system. Furthermore, this study evaluates the predictive power of other prehospital measurements. Materials and methods Prehospital data of 151 minor (Injury Severity Score (ISS) 1-15) and 151 major trauma patients, (ISS>15) treated at a Dutch trauma center, were collected. Logistic regression analysis was used to identify predictors of major trauma patients. Results The major trauma patients particularly incurred severe head injuries (45.7%) and severe thorax injuries (21.9%). The ACSCOT guidelines had a sensitivity of 84.1% and a specificity of 77.5%. A new prehospital trauma triage model was constructed including nine predictors of major trauma. This model identified more major trauma patients than the ACSCOT (sensitivity 92.1%, p=0.023) and resulted in a comparable specificity (79.5%; p=0.711). Conclusion The new triage model outperforms the ACS COT triage guidelines in identifying major trauma patients in the prehospital setting. The new triage guidelines may improve patient outcomes but needs to be validated in a prospective study.

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“…The research was conducted at the Emergency Department of Florence's Ospedale Careggi and reported that many of the patients defined as having major trauma according to physiological or anatomic criteria presented a higher degree of criticality than those referred according to the event dynamics mechanism alone (odds ratio 30.35, 95% confidence interval 21.09-43.65, P<0.0001). 11 Conversely, one research article that conflicts with those mentioned so far, suggests not underestimating the dynamics criterion, especially for falls from a height 12 and one analysis conducted in Australia, as suggested by the American College of Surgeons Committee on Trauma, revealed that in road accidents the longer time required to remove patients from the vehicle is statistically significant for severe injury. 13 Studies have also been conducted on the difference between rapid transfer of polytrauma patients directly to trauma centers and transfer to medical facilities with less-specialized resources that are closer to the event.…”

Section: Introductionmentioning

confidence: 98%

Defining criteria to choose appropriate destination hospital for trauma patients: Piacenza Local Health Authority’s Piacenza trauma algorithm protocol

et al. 2016

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Ambulance crew's choosing of appropriate destination hospital for trauma patients can affect survival and morbidity outcomes. Aim of the present study is to devise a decision-making algorithm in order to allow the best choice of destination hospital for trauma patients and to apply it on an electronic device able to facilitate the decision made by ambulance staff. The method used was analysis of literature data, context and workload with a retrospective observational study. A comparison between the destination hospitals actually chosen and those that could have been chosen with the Piacenza trauma algorithm has been applied. The data shows a 9.5% (P>0.10) more advantageous change in appropriateness in the choice of medical facility and a 1.4% increase in admissions to the Emergency Department of the provincial hospital. The creation and use of a medical protocol and its consequent installation on an electronic device (tablet) that can be shared over a computer platform could help medical staff make appropriate pre-hospital choices as regards the destination hospital for trauma patients.

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“Insignificant” Mechanism of Injury: Not To Be Taken Lightly

Cited by 55 publications

References 9 publications

The Value of the Trauma Mechanism in the Triage of Severely Injured Elderly

The Value of the Trauma Mechanism in the Triage of Severely Injured Elderly

Prehospital identification of major trauma patients

Defining criteria to choose appropriate destination hospital for trauma patients: Piacenza Local Health Authority’s Piacenza trauma algorithm protocol

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