Does mechanism of injury predict trauma center need?

E. Brooke Lerner, Manish N. Shah, Jeremy T. Cushman, Robert A. Swor, Clare E. Guse, Karen Brasel, Alan Blatt, Gregory J. Jurkovich

Research output: Contribution to journalArticle

23 Citations (Scopus)

Abstract

Objective. To determine the predictive value of the mechanism-of-injury step of the American College of Surgeons Field Triage Decision Scheme for determining trauma center need. Methods. Emergency medical services (EMS) providers caring for injured adult patients transported to the regional trauma center in three midsized communities over two years were interviewed upon emergency department (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 nonorthopedic surgery within 24 hours, had intensive care unit admission, or died prior to hospital discharge. Data were analyzed by calculating positive likelihood ratios (+LRs) and 95% confidence intervals (CIs) for each mechanism-of-injury criterion. Results. A total of 11,892 provider interviews were conducted. Of those, one was 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 whom needed the resources of a trauma center. Criteria with a +LR ≥5 were death of another occupant in the same vehicle (6.8; CI: 2.716.7), fall >20 feet (5.3; CI: 2.411.4), and motor vehicle crash (MVC) extrication time >20 minutes (5.1; CI: 3.28.1). Criteria with a +LR between >2 and 12 inches (4.2; CI: 2.95.9), ejection (3.2; CI: 1.38.2), and deformity >20 inches (2.5; CI: 1.93.2). The criteria with a +LR ≤2 were MVC speed >40 mph (2.0; CI: 1.72.4), pedestrian/bicyclist struck at a speed >5 mph (1.2; CI:1.11.4), bicyclist/pedestrian thrown or run over (1.2; CI: 0.91.6), motorcycle crash at a speed >20 mph (1.2; CI: 1.11.4), rider separated from motorcycle (1.0; CI: 0.91.2), and MVC rollover (1.0; CI: 0.71.5). 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. Key words: wounds and injury; triage; emergency medical services; emergency medical technicians; predictors; mechanism of injury; trauma center

Original languageEnglish (US)
Pages (from-to)518-525
Number of pages8
JournalPrehospital Emergency Care
Volume15
Issue number4
DOIs
StatePublished - Oct 2011
Externally publishedYes

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Trauma Centers
Confidence Intervals
Wounds and Injuries
Triage
Motor Vehicles
Motorcycles
Emergency Medical Services
Emergency Medical Technicians
Interviews
Intensive Care Units
Hospital Emergency Service

ASJC Scopus subject areas

  • Emergency Medicine
  • Emergency
  • Medicine(all)

Cite this

Lerner, E. B., Shah, M. N., Cushman, J. T., Swor, R. A., Guse, C. E., Brasel, K., ... Jurkovich, G. J. (2011). Does mechanism of injury predict trauma center need? Prehospital Emergency Care, 15(4), 518-525. https://doi.org/10.3109/10903127.2011.598617

Does mechanism of injury predict trauma center need? / Lerner, E. Brooke; Shah, Manish N.; Cushman, Jeremy T.; Swor, Robert A.; Guse, Clare E.; Brasel, Karen; Blatt, Alan; Jurkovich, Gregory J.

In: Prehospital Emergency Care, Vol. 15, No. 4, 10.2011, p. 518-525.

Research output: Contribution to journalArticle

Lerner, EB, Shah, MN, Cushman, JT, Swor, RA, Guse, CE, Brasel, K, Blatt, A & Jurkovich, GJ 2011, 'Does mechanism of injury predict trauma center need?', Prehospital Emergency Care, vol. 15, no. 4, pp. 518-525. https://doi.org/10.3109/10903127.2011.598617
Lerner, E. Brooke ; Shah, Manish N. ; Cushman, Jeremy T. ; Swor, Robert A. ; Guse, Clare E. ; Brasel, Karen ; Blatt, Alan ; Jurkovich, Gregory J. / Does mechanism of injury predict trauma center need?. In: Prehospital Emergency Care. 2011 ; Vol. 15, No. 4. pp. 518-525.
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abstract = "Objective. To determine the predictive value of the mechanism-of-injury step of the American College of Surgeons Field Triage Decision Scheme for determining trauma center need. Methods. Emergency medical services (EMS) providers caring for injured adult patients transported to the regional trauma center in three midsized communities over two years were interviewed upon emergency department (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 nonorthopedic surgery within 24 hours, had intensive care unit admission, or died prior to hospital discharge. Data were analyzed by calculating positive likelihood ratios (+LRs) and 95{\%} confidence intervals (CIs) for each mechanism-of-injury criterion. Results. A total of 11,892 provider interviews were conducted. Of those, one was 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 whom needed the resources of a trauma center. Criteria with a +LR ≥5 were death of another occupant in the same vehicle (6.8; CI: 2.716.7), fall >20 feet (5.3; CI: 2.411.4), and motor vehicle crash (MVC) extrication time >20 minutes (5.1; CI: 3.28.1). Criteria with a +LR between >2 and 12 inches (4.2; CI: 2.95.9), ejection (3.2; CI: 1.38.2), and deformity >20 inches (2.5; CI: 1.93.2). The criteria with a +LR ≤2 were MVC speed >40 mph (2.0; CI: 1.72.4), pedestrian/bicyclist struck at a speed >5 mph (1.2; CI:1.11.4), bicyclist/pedestrian thrown or run over (1.2; CI: 0.91.6), motorcycle crash at a speed >20 mph (1.2; CI: 1.11.4), rider separated from motorcycle (1.0; CI: 0.91.2), and MVC rollover (1.0; CI: 0.71.5). 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. Key words: wounds and injury; triage; emergency medical services; emergency medical technicians; predictors; mechanism of injury; trauma center",
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AU - Lerner, E. Brooke

AU - Shah, Manish N.

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AU - Brasel, Karen

AU - Blatt, Alan

AU - Jurkovich, Gregory J.

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N2 - Objective. To determine the predictive value of the mechanism-of-injury step of the American College of Surgeons Field Triage Decision Scheme for determining trauma center need. Methods. Emergency medical services (EMS) providers caring for injured adult patients transported to the regional trauma center in three midsized communities over two years were interviewed upon emergency department (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 nonorthopedic surgery within 24 hours, had intensive care unit admission, or died prior to hospital discharge. Data were analyzed by calculating positive likelihood ratios (+LRs) and 95% confidence intervals (CIs) for each mechanism-of-injury criterion. Results. A total of 11,892 provider interviews were conducted. Of those, one was 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 whom needed the resources of a trauma center. Criteria with a +LR ≥5 were death of another occupant in the same vehicle (6.8; CI: 2.716.7), fall >20 feet (5.3; CI: 2.411.4), and motor vehicle crash (MVC) extrication time >20 minutes (5.1; CI: 3.28.1). Criteria with a +LR between >2 and 12 inches (4.2; CI: 2.95.9), ejection (3.2; CI: 1.38.2), and deformity >20 inches (2.5; CI: 1.93.2). The criteria with a +LR ≤2 were MVC speed >40 mph (2.0; CI: 1.72.4), pedestrian/bicyclist struck at a speed >5 mph (1.2; CI:1.11.4), bicyclist/pedestrian thrown or run over (1.2; CI: 0.91.6), motorcycle crash at a speed >20 mph (1.2; CI: 1.11.4), rider separated from motorcycle (1.0; CI: 0.91.2), and MVC rollover (1.0; CI: 0.71.5). 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. Key words: wounds and injury; triage; emergency medical services; emergency medical technicians; predictors; mechanism of injury; trauma center

AB - Objective. To determine the predictive value of the mechanism-of-injury step of the American College of Surgeons Field Triage Decision Scheme for determining trauma center need. Methods. Emergency medical services (EMS) providers caring for injured adult patients transported to the regional trauma center in three midsized communities over two years were interviewed upon emergency department (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 nonorthopedic surgery within 24 hours, had intensive care unit admission, or died prior to hospital discharge. Data were analyzed by calculating positive likelihood ratios (+LRs) and 95% confidence intervals (CIs) for each mechanism-of-injury criterion. Results. A total of 11,892 provider interviews were conducted. Of those, one was 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 whom needed the resources of a trauma center. Criteria with a +LR ≥5 were death of another occupant in the same vehicle (6.8; CI: 2.716.7), fall >20 feet (5.3; CI: 2.411.4), and motor vehicle crash (MVC) extrication time >20 minutes (5.1; CI: 3.28.1). Criteria with a +LR between >2 and 12 inches (4.2; CI: 2.95.9), ejection (3.2; CI: 1.38.2), and deformity >20 inches (2.5; CI: 1.93.2). The criteria with a +LR ≤2 were MVC speed >40 mph (2.0; CI: 1.72.4), pedestrian/bicyclist struck at a speed >5 mph (1.2; CI:1.11.4), bicyclist/pedestrian thrown or run over (1.2; CI: 0.91.6), motorcycle crash at a speed >20 mph (1.2; CI: 1.11.4), rider separated from motorcycle (1.0; CI: 0.91.2), and MVC rollover (1.0; CI: 0.71.5). 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. Key words: wounds and injury; triage; emergency medical services; emergency medical technicians; predictors; mechanism of injury; trauma center

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