Improving the field triage of major trauma victims.
The Trauma Scores, CRAMS scales, and mechanisms of injury of 500 trauma patients were evaluated for their ability to identify a seriously injured patient. Serious injury was defined as one of the following: Injury Severity Score (ISS) greater than 15, or emergency-room Trauma Score less than or equal to 14, or injuries requiring greater than 3 days hospitalization, or death. With the addition of specific mechanisms of injury (auto vs. pedestrian accident at greater than 5 m.p.h., motor vehicle accident at greater than 40 m.p.h., motorcycle accident at greater than 20 m.p.h., or a major assault), the sensitivity of a field Trauma Score of less than 14 could be improved from 45% to 75%, with a reasonable specificity of 40%. With these same mechanisms, the sensitivity of a CRAMS scale of less than or equal to 8 increased from 66% to 93%, with a specificity of 30%. The addition of these mechanisms of injury to standard field triage scoring appears to improve the identification of seriously injured patients while retaining an acceptable level of overtriage.
Knudson
P
P
Department of Trauma, San Jose Hospital, California 95112.
Frecceri
C A
CA
DeLateur
S A
SA
D000058:Accidental Falls; D000063:Accidents, Traffic; D000293:Adolescent; D000328:Adult; D002648:Child; D002675:Child, Preschool; D004632:Emergency Medical Services; D005069:Evaluation Studies as Topic; D006801:Humans; D007223:Infant; D008499:Medical Records; D008875:Middle Aged; D014193:Trauma Centers; D014218:Triage; D014947:Wounds and Injuries / Q000175:diagnosis* / Q000401:mortality