A critical assessment of the out-of-hospital trauma triage guidelines for physiologic abnormality

Craig Newgard, Kyle Rudser, Jerris R. Hedges, Jeffrey D. Kerby, Ian G. Stiell, Daniel P. Davis, Laurie J. Morrison, Eileen Bulger, Tom Terndrup, Joseph P. Minei, Berit Bardarson, Scott Emerson

Research output: Contribution to journalArticle

34 Citations (Scopus)

Abstract

Background: It remains unclear whether the American College of Surgeons Committee on Trauma (ACSCOT) "step 1" field physiologic criteria could be further restricted without substantially sacrificing sensitivity. We assessed whether more restrictive physiologic criteria would improve the specificity of this triage step without missing high-risk patients. Methods: We analyzed an out-of-hospital, consecutive patient, prospective cohort of injured adults ≥15 years collected from December 1, 2005, to February 28, 2007, by 237 emergency medical service agencies transporting to 207 acute care hospitals in 11 sites across the United States and Canada. Patients were included based on ACSCOT field decision scheme physiologic criteria systolic blood pressure ≤90, respiratory rate 29 breaths/min, Glasgow Coma Scale score ≤12, or field intubation. Seven field physiologic variables and four additional demographic and mechanism variables were included in the analysis. The composite outcome was mortality (field or in-hospital) or hospital length of stay >2 days. Results: Of 7,127 injured persons, 6,259 had complete outcome information and were included in the analysis. There were 3,631 (58.0%) persons with death or LOS >2 days. Using only physiologic measures, the derived rule included advanced airway intervention, shock index >1.4, Glasgow Coma Scale

Original languageEnglish (US)
Pages (from-to)452-462
Number of pages11
JournalJournal of Trauma - Injury, Infection and Critical Care
Volume68
Issue number2
DOIs
StatePublished - Feb 2010

Fingerprint

Triage
Glasgow Coma Scale
Guidelines
Length of Stay
Wounds and Injuries
Blood Pressure
Emergency Medical Services
Respiratory Rate
Intubation
Canada
Shock
Demography
Mortality

Keywords

  • Emergency medical services
  • Out-ofhospital
  • Physiologic
  • Trauma
  • Triage

ASJC Scopus subject areas

  • Surgery
  • Critical Care and Intensive Care Medicine

Cite this

A critical assessment of the out-of-hospital trauma triage guidelines for physiologic abnormality. / Newgard, Craig; Rudser, Kyle; Hedges, Jerris R.; Kerby, Jeffrey D.; Stiell, Ian G.; Davis, Daniel P.; Morrison, Laurie J.; Bulger, Eileen; Terndrup, Tom; Minei, Joseph P.; Bardarson, Berit; Emerson, Scott.

In: Journal of Trauma - Injury, Infection and Critical Care, Vol. 68, No. 2, 02.2010, p. 452-462.

Research output: Contribution to journalArticle

Newgard, C, Rudser, K, Hedges, JR, Kerby, JD, Stiell, IG, Davis, DP, Morrison, LJ, Bulger, E, Terndrup, T, Minei, JP, Bardarson, B & Emerson, S 2010, 'A critical assessment of the out-of-hospital trauma triage guidelines for physiologic abnormality', Journal of Trauma - Injury, Infection and Critical Care, vol. 68, no. 2, pp. 452-462. https://doi.org/10.1097/TA.0b013e3181ae20c9
Newgard, Craig ; Rudser, Kyle ; Hedges, Jerris R. ; Kerby, Jeffrey D. ; Stiell, Ian G. ; Davis, Daniel P. ; Morrison, Laurie J. ; Bulger, Eileen ; Terndrup, Tom ; Minei, Joseph P. ; Bardarson, Berit ; Emerson, Scott. / A critical assessment of the out-of-hospital trauma triage guidelines for physiologic abnormality. In: Journal of Trauma - Injury, Infection and Critical Care. 2010 ; Vol. 68, No. 2. pp. 452-462.
@article{eead4b48ec394cdda0274aff8a53f5d2,
title = "A critical assessment of the out-of-hospital trauma triage guidelines for physiologic abnormality",
abstract = "Background: It remains unclear whether the American College of Surgeons Committee on Trauma (ACSCOT) {"}step 1{"} field physiologic criteria could be further restricted without substantially sacrificing sensitivity. We assessed whether more restrictive physiologic criteria would improve the specificity of this triage step without missing high-risk patients. Methods: We analyzed an out-of-hospital, consecutive patient, prospective cohort of injured adults ≥15 years collected from December 1, 2005, to February 28, 2007, by 237 emergency medical service agencies transporting to 207 acute care hospitals in 11 sites across the United States and Canada. Patients were included based on ACSCOT field decision scheme physiologic criteria systolic blood pressure ≤90, respiratory rate 29 breaths/min, Glasgow Coma Scale score ≤12, or field intubation. Seven field physiologic variables and four additional demographic and mechanism variables were included in the analysis. The composite outcome was mortality (field or in-hospital) or hospital length of stay >2 days. Results: Of 7,127 injured persons, 6,259 had complete outcome information and were included in the analysis. There were 3,631 (58.0{\%}) persons with death or LOS >2 days. Using only physiologic measures, the derived rule included advanced airway intervention, shock index >1.4, Glasgow Coma Scale",
keywords = "Emergency medical services, Out-ofhospital, Physiologic, Trauma, Triage",
author = "Craig Newgard and Kyle Rudser and Hedges, {Jerris R.} and Kerby, {Jeffrey D.} and Stiell, {Ian G.} and Davis, {Daniel P.} and Morrison, {Laurie J.} and Eileen Bulger and Tom Terndrup and Minei, {Joseph P.} and Berit Bardarson and Scott Emerson",
year = "2010",
month = "2",
doi = "10.1097/TA.0b013e3181ae20c9",
language = "English (US)",
volume = "68",
pages = "452--462",
journal = "Journal of Trauma and Acute Care Surgery",
issn = "2163-0755",
publisher = "Lippincott Williams and Wilkins",
number = "2",

}

TY - JOUR

T1 - A critical assessment of the out-of-hospital trauma triage guidelines for physiologic abnormality

AU - Newgard, Craig

AU - Rudser, Kyle

AU - Hedges, Jerris R.

AU - Kerby, Jeffrey D.

AU - Stiell, Ian G.

AU - Davis, Daniel P.

AU - Morrison, Laurie J.

AU - Bulger, Eileen

AU - Terndrup, Tom

AU - Minei, Joseph P.

AU - Bardarson, Berit

AU - Emerson, Scott

PY - 2010/2

Y1 - 2010/2

N2 - Background: It remains unclear whether the American College of Surgeons Committee on Trauma (ACSCOT) "step 1" field physiologic criteria could be further restricted without substantially sacrificing sensitivity. We assessed whether more restrictive physiologic criteria would improve the specificity of this triage step without missing high-risk patients. Methods: We analyzed an out-of-hospital, consecutive patient, prospective cohort of injured adults ≥15 years collected from December 1, 2005, to February 28, 2007, by 237 emergency medical service agencies transporting to 207 acute care hospitals in 11 sites across the United States and Canada. Patients were included based on ACSCOT field decision scheme physiologic criteria systolic blood pressure ≤90, respiratory rate 29 breaths/min, Glasgow Coma Scale score ≤12, or field intubation. Seven field physiologic variables and four additional demographic and mechanism variables were included in the analysis. The composite outcome was mortality (field or in-hospital) or hospital length of stay >2 days. Results: Of 7,127 injured persons, 6,259 had complete outcome information and were included in the analysis. There were 3,631 (58.0%) persons with death or LOS >2 days. Using only physiologic measures, the derived rule included advanced airway intervention, shock index >1.4, Glasgow Coma Scale

AB - Background: It remains unclear whether the American College of Surgeons Committee on Trauma (ACSCOT) "step 1" field physiologic criteria could be further restricted without substantially sacrificing sensitivity. We assessed whether more restrictive physiologic criteria would improve the specificity of this triage step without missing high-risk patients. Methods: We analyzed an out-of-hospital, consecutive patient, prospective cohort of injured adults ≥15 years collected from December 1, 2005, to February 28, 2007, by 237 emergency medical service agencies transporting to 207 acute care hospitals in 11 sites across the United States and Canada. Patients were included based on ACSCOT field decision scheme physiologic criteria systolic blood pressure ≤90, respiratory rate 29 breaths/min, Glasgow Coma Scale score ≤12, or field intubation. Seven field physiologic variables and four additional demographic and mechanism variables were included in the analysis. The composite outcome was mortality (field or in-hospital) or hospital length of stay >2 days. Results: Of 7,127 injured persons, 6,259 had complete outcome information and were included in the analysis. There were 3,631 (58.0%) persons with death or LOS >2 days. Using only physiologic measures, the derived rule included advanced airway intervention, shock index >1.4, Glasgow Coma Scale

KW - Emergency medical services

KW - Out-ofhospital

KW - Physiologic

KW - Trauma

KW - Triage

UR - http://www.scopus.com/inward/record.url?scp=77249119330&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=77249119330&partnerID=8YFLogxK

U2 - 10.1097/TA.0b013e3181ae20c9

DO - 10.1097/TA.0b013e3181ae20c9

M3 - Article

C2 - 20154558

AN - SCOPUS:77249119330

VL - 68

SP - 452

EP - 462

JO - Journal of Trauma and Acute Care Surgery

JF - Journal of Trauma and Acute Care Surgery

SN - 2163-0755

IS - 2

ER -