Prospective Validation of the National Field Triage Guidelines for Identifying Seriously Injured Persons

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• 作者：Craig D. Newgard ; MD ; MPH^a ; ^{newgardc@ohsu.edu" class="auth_mail" title="E-mail the corresponding author} ; Rongwei Fu ; PhD^a ; ^b ; Dana Zive ; MPH^a ; Tom Rea ; MD ; MPH^k ; ^m ; Susan Malveau ; MS^a ; Mohamud Daya ; MD ; MS^a ; ^f ; Jonathan Jui ; MD ; MPH^a ; ^c ; Denise E. Griffiths ; BS ; CCRP^a ; Lynn Wittwer ; MDⁿ ; ^o ; Ritu Sahni ; MD ; MPH^d ; ^g ; K. Dean Gubler ; DO ; MPH ; FACS^e ; Jonathan Chin ; BS^h ; Pat Klotz ; RN^l ; Stephanie Somerville ; BSNⁱ ; Tina Beeler ; PM^j ; T.J. Bishop ; AS ; NRP ; NCEE^p ; Tara N. Garland ; BS^l ; Eileen Bulger ; MD ; FACS^l
• 关键词：ACS COT ; American College of Surgeons Committee on Trauma ; ALS ; advanced life support ; ED ; emergency department ; EMS ; Emergency Medical Services ; ISS ; Injury Severity Score
• 刊名：Journal of the American College of Surgeons
• 出版年：2016
• 出版时间：February 2016
• 年：2016
• 卷：222
• 期：2
• 页码：146-158.e2
• 全文大小：2757 K

文摘

The national field trauma triage guidelines have been widely implemented in US trauma systems, but never prospectively validated. We sought to prospectively validate the guidelines, as applied by out-of-hospital providers, for identifying high-risk trauma patients.

Study Design

This was an out-of-hospital prospective cohort study from January 1, 2011 through December 31, 2011 with 44 Emergency Medical Services agencies in 7 counties in 2 states. We enrolled injured patients transported to 28 acute care hospitals, including 7 major trauma centers (Level I and II trauma hospitals) and 21 nontrauma hospitals. The primary exposure term was Emergency Medical Services' use of one or more field triage criteria in the national field triage guidelines. Outcomes included Injured Severity Score ≥16 (primary) and critical resource use within 24 hours of emergency department arrival (secondary).

Results

We enrolled 53,487 injured children and adults transported by Emergency Medical Services to an acute care hospital, 17,633 of which were sampled for the primary analysis; 13.9% met field triage guidelines, 3.1% had Injury Severity Score ≥16, and 1.7% required early critical resources. The sensitivity and specificity of the field triage guidelines were 66.2% (95% CI, 60.2–71.7%) and 87.8% (95% CI, 87.7–88.0%) for Injury Severity Score ≥16 and 80.1% (95% CI, 65.8–89.4%) and 87.3% (95% CI 87.1–87.4%) for early critical resource use. Triage guideline sensitivity decreased with age, from 87.4% in children to 51.8% in older adults.

Conclusions

The national field triage guidelines are relatively insensitive for identifying seriously injured patients and patients requiring early critical interventions, particularly among older adults.