TY - JOUR
T1 - Validation and refinement of a rule to predict emergency intervention in adult trauma patients
AU - Haukoos, Jason S.
AU - Byyny, Richard L.
AU - Erickson, Catherine
AU - Paulson, Stephen
AU - Hopkins, Emily
AU - Sasson, Comilla
AU - Bender, Brooke
AU - Gravitz, Craig S.
AU - Vogel, Jody A.
AU - Colwell, Christopher B.
AU - Moore, Ernest E.
N1 - Funding Information:
Funding and support: By Annals policy, all authors are required to disclose any and all commercial, financial, and other relationships in any way related to the subject of this article as per ICMJE conflict of interest guidelines (see www.icmje.org ). This study was funded by grants from the Colorado chapter of the American College of Emergency Physicians (ACEP) (Dr. Erickson) and the Emergency Medicine Foundation (EMF) (Dr. Paulson) and supported in part by an Independent Scientist Award ( K02 HS017526 ) from the Agency for Healthcare Research and Quality (AHRQ) (Dr. Haukoos). Dr. Haukoos has received support from the Centers for Disease Control and Prevention (CDC) and the AHRQ. Dr. Erickson has received support from the Colorado chapter of ACEP. Dr. Paulson has received support from the EMF. Ms. Hopkins has received support from the CDC. The Colorado chapter of ACEP, the EMF, and the AHRQ had no role in the design or conduct of the study, collection, management, analysis, or interpretation of the data, or review of the article.
PY - 2011/8
Y1 - 2011/8
N2 - Study objective: Trauma centers use "secondary triage" to determine the necessity of trauma surgeon involvement. A clinical decision rule, which includes penetrating injury, an initial systolic blood pressure less than 100 mm Hg, or an initial pulse rate greater than 100 beats/min, was developed to predict which trauma patients require emergency operative intervention or emergency procedural intervention (cricothyroidotomy or thoracotomy) in the emergency department. Our goal was to validate this rule in an adult trauma population and to compare it with the American College of Surgeons' major resuscitation criteria. Methods: We used Level I trauma center registry data from September 1, 1995, through November 30, 2008. Outcomes were confirmed with blinded abstractors. Sensitivity, specificity, and 95% confidence intervals (CIs) were calculated. Results: Our patient sample included 20,872 individuals. The median Injury Severity Score was 9 (interquartile range 4 to 16), 15.3% of patients had penetrating injuries, 13.5% had a systolic blood pressure less than 100 mm Hg, and 32.5% had a pulse rate greater than 100 beats/min. Emergency operative intervention or procedural intervention was required in 1,099 patients (5.3%; 95% CI 5.0% to 5.6%). The sensitivities and specificities of the rule and the major resuscitation criteria for predicting emergency operative intervention or emergency procedural intervention were 95.6% (95% CI 94.3% to 96.8%) and 56.1% (95% CI 55.4% to 56.8%) and 85.5% (95% CI 83.3% to 87.5%) and 80.9% (95% CI 80.3% to 81.4%), respectively. Conclusion: This new rule was more sensitive for predicting the need for emergency operative intervention or emergency procedural intervention directly compared with the American College of Surgeons' major resuscitation criteria, which may improve the effectiveness and efficiency of trauma triage.
AB - Study objective: Trauma centers use "secondary triage" to determine the necessity of trauma surgeon involvement. A clinical decision rule, which includes penetrating injury, an initial systolic blood pressure less than 100 mm Hg, or an initial pulse rate greater than 100 beats/min, was developed to predict which trauma patients require emergency operative intervention or emergency procedural intervention (cricothyroidotomy or thoracotomy) in the emergency department. Our goal was to validate this rule in an adult trauma population and to compare it with the American College of Surgeons' major resuscitation criteria. Methods: We used Level I trauma center registry data from September 1, 1995, through November 30, 2008. Outcomes were confirmed with blinded abstractors. Sensitivity, specificity, and 95% confidence intervals (CIs) were calculated. Results: Our patient sample included 20,872 individuals. The median Injury Severity Score was 9 (interquartile range 4 to 16), 15.3% of patients had penetrating injuries, 13.5% had a systolic blood pressure less than 100 mm Hg, and 32.5% had a pulse rate greater than 100 beats/min. Emergency operative intervention or procedural intervention was required in 1,099 patients (5.3%; 95% CI 5.0% to 5.6%). The sensitivities and specificities of the rule and the major resuscitation criteria for predicting emergency operative intervention or emergency procedural intervention were 95.6% (95% CI 94.3% to 96.8%) and 56.1% (95% CI 55.4% to 56.8%) and 85.5% (95% CI 83.3% to 87.5%) and 80.9% (95% CI 80.3% to 81.4%), respectively. Conclusion: This new rule was more sensitive for predicting the need for emergency operative intervention or emergency procedural intervention directly compared with the American College of Surgeons' major resuscitation criteria, which may improve the effectiveness and efficiency of trauma triage.
UR - http://www.scopus.com/inward/record.url?scp=79960742352&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=79960742352&partnerID=8YFLogxK
U2 - 10.1016/j.annemergmed.2011.02.027
DO - 10.1016/j.annemergmed.2011.02.027
M3 - Article
C2 - 21658802
AN - SCOPUS:79960742352
SN - 0196-0644
VL - 58
SP - 164
EP - 171
JO - Annals of emergency medicine
JF - Annals of emergency medicine
IS - 2
ER -