Validation of prehospital trauma triage criteria for motor vehicle collisions

Giana H. Davidson, Frederick P. Rivara, Christopher D. Mack, Robert Kaufman, Gregory Jurkovich, Eileen M. Bulger

Research output: Contribution to journalArticle

11 Citations (Scopus)

Abstract

BACKGROUND: Triage of an injured patient to an appropriate trauma center can have an impact on morbidity and mortality. We sought to validate the 2012 national field triage guidelines for motor vehicle crashes. METHODS: This is a retrospective cross-sectional study using the National Automotive Sampling System Crashworthiness Data System. Vehicle damage criteria proposed as prehospital triage guidelines were correlated with injury severity. RESULTS: There were 85,761 individuals representing 29,397,234 occupants in car crashes from 2003 to 2008. Of the patients, 3.8% met physiologic Step 1 criteria with a mean Injury Severity Score (ISS) of 9.1 (95% confidence interval [CI], -3.1 to 20.9); Step 1 had a positive predictive value (PPV) of 20.8% (95% CI, 20.1-21.4%) for severe injury (ISS > 15). Of the patients, 0.43% met anatomic Step 2 criteria alone, with a mean ISS of 18.1 (95% CI, 16.4-19.8) and a PPV of 48.5% (95% CI, 46.8-50.1%). Step 3 criteria include injury mechanism; 3.7% of the patients met one of these criteria alone with a mean ISS of 5.1 (95% CI, 4.4-5.8) and a PPV of 9.7% (95% CI, 9.3-10.2%).Patients who met only Step 3 criteria were examined to determine crash characteristics that predict severe injury. Intrusion of greater than 12 inches had a PPV of 10.4% (95% CI, 9.5-11.3); steering wheel collapse had a PPV of 25.7% (95% CI, 23.0-28.4%). Older patients (age > 55 years) who met Step 3 mechanism criteria had higher predictive values for injury for nearly all crash characteristics. CONCLUSION: Injury mechanism criteria alone predict significant injury in a substantial proportion of patients who did not meet the physiologic or anatomic criteria. Vehicular crash data could improve the ability of emergency medical service providers to triage injured occupants. Consideration of transport to a trauma center should be given for elderly patients and drivers with steering wheel collapse.

Original languageEnglish (US)
Pages (from-to)755-761
Number of pages7
JournalJournal of Trauma and Acute Care Surgery
Volume76
Issue number3
DOIs
StatePublished - Mar 1 2014
Externally publishedYes

Fingerprint

Triage
Motor Vehicles
Confidence Intervals
Injury Severity Score
Wounds and Injuries
Trauma Centers
Guidelines
Emergency Medical Services
Information Systems
Cross-Sectional Studies
Morbidity
Mortality

Keywords

  • Mechanism of injury
  • Motor vehicle crash
  • Trauma center
  • Triage

ASJC Scopus subject areas

  • Surgery
  • Critical Care and Intensive Care Medicine

Cite this

Validation of prehospital trauma triage criteria for motor vehicle collisions. / Davidson, Giana H.; Rivara, Frederick P.; Mack, Christopher D.; Kaufman, Robert; Jurkovich, Gregory; Bulger, Eileen M.

In: Journal of Trauma and Acute Care Surgery, Vol. 76, No. 3, 01.03.2014, p. 755-761.

Research output: Contribution to journalArticle

Davidson, Giana H. ; Rivara, Frederick P. ; Mack, Christopher D. ; Kaufman, Robert ; Jurkovich, Gregory ; Bulger, Eileen M. / Validation of prehospital trauma triage criteria for motor vehicle collisions. In: Journal of Trauma and Acute Care Surgery. 2014 ; Vol. 76, No. 3. pp. 755-761.
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AU - Jurkovich, Gregory

AU - Bulger, Eileen M.

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N2 - BACKGROUND: Triage of an injured patient to an appropriate trauma center can have an impact on morbidity and mortality. We sought to validate the 2012 national field triage guidelines for motor vehicle crashes. METHODS: This is a retrospective cross-sectional study using the National Automotive Sampling System Crashworthiness Data System. Vehicle damage criteria proposed as prehospital triage guidelines were correlated with injury severity. RESULTS: There were 85,761 individuals representing 29,397,234 occupants in car crashes from 2003 to 2008. Of the patients, 3.8% met physiologic Step 1 criteria with a mean Injury Severity Score (ISS) of 9.1 (95% confidence interval [CI], -3.1 to 20.9); Step 1 had a positive predictive value (PPV) of 20.8% (95% CI, 20.1-21.4%) for severe injury (ISS > 15). Of the patients, 0.43% met anatomic Step 2 criteria alone, with a mean ISS of 18.1 (95% CI, 16.4-19.8) and a PPV of 48.5% (95% CI, 46.8-50.1%). Step 3 criteria include injury mechanism; 3.7% of the patients met one of these criteria alone with a mean ISS of 5.1 (95% CI, 4.4-5.8) and a PPV of 9.7% (95% CI, 9.3-10.2%).Patients who met only Step 3 criteria were examined to determine crash characteristics that predict severe injury. Intrusion of greater than 12 inches had a PPV of 10.4% (95% CI, 9.5-11.3); steering wheel collapse had a PPV of 25.7% (95% CI, 23.0-28.4%). Older patients (age > 55 years) who met Step 3 mechanism criteria had higher predictive values for injury for nearly all crash characteristics. CONCLUSION: Injury mechanism criteria alone predict significant injury in a substantial proportion of patients who did not meet the physiologic or anatomic criteria. Vehicular crash data could improve the ability of emergency medical service providers to triage injured occupants. Consideration of transport to a trauma center should be given for elderly patients and drivers with steering wheel collapse.

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