How Well Do EMS Providers Predict Intracranial Hemorrhage in Head-Injured Older Adults?

for the Sacramento County Prehospital Research Consortium

Research output: Contribution to journalArticle

Abstract

Objective: To evaluate the accuracy of emergency medical services (EMS) provider judgment for traumatic intracranial hemorrhage (tICH) in older patients following head trauma in the field. We also compared EMS provider judgment with other sets of field triage criteria. Methods: This was a prospective observational cohort study conducted with five EMS agencies and 11 hospitals in Northern California. Patients 55 years and older who experienced blunt head trauma were transported by EMS between August 1, 2015 and September 30, 2016, and received an initial cranial computed tomography (CT) imaging, were eligible. EMS providers were asked, “What is your suspicion for the patient having intracranial hemorrhage (bleeding in the brain)?” Responses were recorded as ordinal categories (<1%, 1–5%, >5–10%, >10–50%, or >50%) and the incidences of tICH were recorded for each category. The accuracy of EMS provider judgment was compared to other sets of triage criteria, including current field triage criteria, current field triage criteria plus multivariate logistical regression risk factors, and actual transport. Results: Among the 673 patients enrolled, 319 (47.0%) were male and the median age was 75 years (interquartile range 64–85). Seventy-six (11.3%) patients had tICH on initial cranial CT imaging. The increase in EMS provider judgment correlated with an increase in the incidence of tICH. EMS provider judgment had a sensitivity of 77.6% (95% CI 67.1–85.5%) and a specificity of 41.5% (37.7–45.5%) when using a threshold of 1% or higher suspicion for tICH. Current field triage criteria (Steps 1–3) was poorly sensitive (26.3%, 95% CI 17.7–37.2%) in identifying tICH and current field trial criteria plus multivariate logistical regression risk factors was sensitive (97.4%, 95% CI 90.9–99.3%) but poorly specific (12.9%, 95% CI 10.4–15.8%). Actual transport was comparable to EMS provider judgment (sensitivity 71.1%, 95% CI 60.0–80.0%; specificity 35.3%, 95% CI 31.6–38.3%). Conclusions: As EMS provider judgment for tICH increased, the incidence for tICH also increased. EMS provider judgment, using a threshold of 1% or higher suspicion for tICH, was more accurate than current field triage criteria, with and without additional risk factors included.

Original languageEnglish (US)
JournalPrehospital Emergency Care
DOIs
StatePublished - Jan 1 2019

Fingerprint

Traumatic Intracranial Hemorrhage
Intracranial Hemorrhages
Emergency Medical Services
Head
Triage
Craniocerebral Trauma
Incidence
Tomography
Observational Studies
Cohort Studies

Keywords

  • closed
  • emergency medical services
  • head injuries

ASJC Scopus subject areas

  • Emergency Medicine
  • Emergency

Cite this

How Well Do EMS Providers Predict Intracranial Hemorrhage in Head-Injured Older Adults? / for the Sacramento County Prehospital Research Consortium.

In: Prehospital Emergency Care, 01.01.2019.

Research output: Contribution to journalArticle

@article{6c171ddf680248c78d9e67fdc173ec63,
title = "How Well Do EMS Providers Predict Intracranial Hemorrhage in Head-Injured Older Adults?",
abstract = "Objective: To evaluate the accuracy of emergency medical services (EMS) provider judgment for traumatic intracranial hemorrhage (tICH) in older patients following head trauma in the field. We also compared EMS provider judgment with other sets of field triage criteria. Methods: This was a prospective observational cohort study conducted with five EMS agencies and 11 hospitals in Northern California. Patients 55 years and older who experienced blunt head trauma were transported by EMS between August 1, 2015 and September 30, 2016, and received an initial cranial computed tomography (CT) imaging, were eligible. EMS providers were asked, “What is your suspicion for the patient having intracranial hemorrhage (bleeding in the brain)?” Responses were recorded as ordinal categories (<1{\%}, 1–5{\%}, >5–10{\%}, >10–50{\%}, or >50{\%}) and the incidences of tICH were recorded for each category. The accuracy of EMS provider judgment was compared to other sets of triage criteria, including current field triage criteria, current field triage criteria plus multivariate logistical regression risk factors, and actual transport. Results: Among the 673 patients enrolled, 319 (47.0{\%}) were male and the median age was 75 years (interquartile range 64–85). Seventy-six (11.3{\%}) patients had tICH on initial cranial CT imaging. The increase in EMS provider judgment correlated with an increase in the incidence of tICH. EMS provider judgment had a sensitivity of 77.6{\%} (95{\%} CI 67.1–85.5{\%}) and a specificity of 41.5{\%} (37.7–45.5{\%}) when using a threshold of 1{\%} or higher suspicion for tICH. Current field triage criteria (Steps 1–3) was poorly sensitive (26.3{\%}, 95{\%} CI 17.7–37.2{\%}) in identifying tICH and current field trial criteria plus multivariate logistical regression risk factors was sensitive (97.4{\%}, 95{\%} CI 90.9–99.3{\%}) but poorly specific (12.9{\%}, 95{\%} CI 10.4–15.8{\%}). Actual transport was comparable to EMS provider judgment (sensitivity 71.1{\%}, 95{\%} CI 60.0–80.0{\%}; specificity 35.3{\%}, 95{\%} CI 31.6–38.3{\%}). Conclusions: As EMS provider judgment for tICH increased, the incidence for tICH also increased. EMS provider judgment, using a threshold of 1{\%} or higher suspicion for tICH, was more accurate than current field triage criteria, with and without additional risk factors included.",
keywords = "closed, emergency medical services, head injuries",
author = "{for the Sacramento County Prehospital Research Consortium} and Simson Hon and Gaona, {Samuel D.} and Mark Faul and {Holmes Jr}, {James F} and Daniel Nishijima",
year = "2019",
month = "1",
day = "1",
doi = "10.1080/10903127.2019.1597954",
language = "English (US)",
journal = "Prehospital Emergency Care",
issn = "1090-3127",
publisher = "Informa Healthcare",

}

TY - JOUR

T1 - How Well Do EMS Providers Predict Intracranial Hemorrhage in Head-Injured Older Adults?

AU - for the Sacramento County Prehospital Research Consortium

AU - Hon, Simson

AU - Gaona, Samuel D.

AU - Faul, Mark

AU - Holmes Jr, James F

AU - Nishijima, Daniel

PY - 2019/1/1

Y1 - 2019/1/1

N2 - Objective: To evaluate the accuracy of emergency medical services (EMS) provider judgment for traumatic intracranial hemorrhage (tICH) in older patients following head trauma in the field. We also compared EMS provider judgment with other sets of field triage criteria. Methods: This was a prospective observational cohort study conducted with five EMS agencies and 11 hospitals in Northern California. Patients 55 years and older who experienced blunt head trauma were transported by EMS between August 1, 2015 and September 30, 2016, and received an initial cranial computed tomography (CT) imaging, were eligible. EMS providers were asked, “What is your suspicion for the patient having intracranial hemorrhage (bleeding in the brain)?” Responses were recorded as ordinal categories (<1%, 1–5%, >5–10%, >10–50%, or >50%) and the incidences of tICH were recorded for each category. The accuracy of EMS provider judgment was compared to other sets of triage criteria, including current field triage criteria, current field triage criteria plus multivariate logistical regression risk factors, and actual transport. Results: Among the 673 patients enrolled, 319 (47.0%) were male and the median age was 75 years (interquartile range 64–85). Seventy-six (11.3%) patients had tICH on initial cranial CT imaging. The increase in EMS provider judgment correlated with an increase in the incidence of tICH. EMS provider judgment had a sensitivity of 77.6% (95% CI 67.1–85.5%) and a specificity of 41.5% (37.7–45.5%) when using a threshold of 1% or higher suspicion for tICH. Current field triage criteria (Steps 1–3) was poorly sensitive (26.3%, 95% CI 17.7–37.2%) in identifying tICH and current field trial criteria plus multivariate logistical regression risk factors was sensitive (97.4%, 95% CI 90.9–99.3%) but poorly specific (12.9%, 95% CI 10.4–15.8%). Actual transport was comparable to EMS provider judgment (sensitivity 71.1%, 95% CI 60.0–80.0%; specificity 35.3%, 95% CI 31.6–38.3%). Conclusions: As EMS provider judgment for tICH increased, the incidence for tICH also increased. EMS provider judgment, using a threshold of 1% or higher suspicion for tICH, was more accurate than current field triage criteria, with and without additional risk factors included.

AB - Objective: To evaluate the accuracy of emergency medical services (EMS) provider judgment for traumatic intracranial hemorrhage (tICH) in older patients following head trauma in the field. We also compared EMS provider judgment with other sets of field triage criteria. Methods: This was a prospective observational cohort study conducted with five EMS agencies and 11 hospitals in Northern California. Patients 55 years and older who experienced blunt head trauma were transported by EMS between August 1, 2015 and September 30, 2016, and received an initial cranial computed tomography (CT) imaging, were eligible. EMS providers were asked, “What is your suspicion for the patient having intracranial hemorrhage (bleeding in the brain)?” Responses were recorded as ordinal categories (<1%, 1–5%, >5–10%, >10–50%, or >50%) and the incidences of tICH were recorded for each category. The accuracy of EMS provider judgment was compared to other sets of triage criteria, including current field triage criteria, current field triage criteria plus multivariate logistical regression risk factors, and actual transport. Results: Among the 673 patients enrolled, 319 (47.0%) were male and the median age was 75 years (interquartile range 64–85). Seventy-six (11.3%) patients had tICH on initial cranial CT imaging. The increase in EMS provider judgment correlated with an increase in the incidence of tICH. EMS provider judgment had a sensitivity of 77.6% (95% CI 67.1–85.5%) and a specificity of 41.5% (37.7–45.5%) when using a threshold of 1% or higher suspicion for tICH. Current field triage criteria (Steps 1–3) was poorly sensitive (26.3%, 95% CI 17.7–37.2%) in identifying tICH and current field trial criteria plus multivariate logistical regression risk factors was sensitive (97.4%, 95% CI 90.9–99.3%) but poorly specific (12.9%, 95% CI 10.4–15.8%). Actual transport was comparable to EMS provider judgment (sensitivity 71.1%, 95% CI 60.0–80.0%; specificity 35.3%, 95% CI 31.6–38.3%). Conclusions: As EMS provider judgment for tICH increased, the incidence for tICH also increased. EMS provider judgment, using a threshold of 1% or higher suspicion for tICH, was more accurate than current field triage criteria, with and without additional risk factors included.

KW - closed

KW - emergency medical services

KW - head injuries

UR - http://www.scopus.com/inward/record.url?scp=85064806205&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85064806205&partnerID=8YFLogxK

U2 - 10.1080/10903127.2019.1597954

DO - 10.1080/10903127.2019.1597954

M3 - Article

AN - SCOPUS:85064806205

JO - Prehospital Emergency Care

JF - Prehospital Emergency Care

SN - 1090-3127

ER -