Applying the trauma triage rule to blunt trauma patients.
OBJECTIVE
To determine the accuracy of the Baxt Trauma Triage Rule (TTR: systolic blood pressure < 85 mm Hg; Glasgow Coma Scale-motor score < 5; or penetrating trauma to head, neck, or trunk) for prediction of major trauma in an independent data set of blunt trauma patients.


METHODS
Retrospective evaluation of the TTR in a cohort of patients identified by Oregon Trauma System entry criteria. Accuracy for prediction of "major trauma" victims was measured using resource-based definitions of major trauma. Participants included 626 adult, blunt trauma patients at a level-I trauma center serving a metropolitan center of more than one million people.


RESULTS
Of 524 patients with sufficient registry data to apply the TTR, 95 (18%) and 63 (12%) patients met the criteria for major trauma suggested by Baxt et al. and Emerman et al., respectively. Using the Baxt definition of major trauma, the TTR had a sensitivity of 74% (95% CI: 0.65-0.83) and a specificity of 84% (95% CI: 0.81-0.88). There were 25 significant false-negative results, including 12 patients requiring urgent laparotomy and four patients requiring emergency airway procedures. Using the Emerman definition of major trauma, sensitivity improved modestly to 76% (95% CI: 0.65-0.87) and specificity decreased slightly to 80% (95% CI: 0.77-0.84).


CONCLUSIONS
In this blunt trauma population, the Baxt TTR failed to identify a significant number of severely injured patients. Slight alterations in the definition of "major trauma" can significantly affect the performance characteristics of triage instruments.
Zechnich
A D
AD
Oregon Health Sciences University, Department of Emergency Medicine, Portland 97201-3098, USA.
Hedges
J R
JR
Spackman
K
K
Jui
J
J
Mullins
R J
RJ
D000293:Adolescent; D000328:Adult; D015331:Cohort Studies; D005069:Evaluation Studies as Topic; D005260:Female; D015600:Glasgow Coma Scale; D006801:Humans; D015601:Injury Severity Score; D008297:Male; D009922:Oregon; D012042:Registries; D012189:Retrospective Studies; D012680:Sensitivity and Specificity; D014218:Triage / Q000379:methods / Q000592:standards; D014949:Wounds, Nonpenetrating / Q000145:classification / Q000401:mortality / Q000628:therapy