Field trauma triage: combining mechanism of injury with the prehospital index for an improved trauma triage tool.
BACKGROUND
The objective of this study was to combine a physiologic triage score (prehospital index, PHI) with criteria regarding mechanism of injury (MOI) to increase the efficacy of trauma triage. The specific question being asked was: will the combined score improve the sensitivity and specificity over that of the individual scores?


METHODS
In this prospective study, 3,147 injury patients (all adults > or = 14 years) were reviewed. Each patient received a PHI score and a MOI score in the field, which were compared with their Injury Severity Score (ISS) at separation. An ISS > or = 16 was defined as major trauma.


RESULTS
PHI alone had a sensitivity of 41%, MOI alone had a sensitivity of 73%, whereas the combined PHI/MOI score had a sensitivity of 78%. All three had similar specificities. These findings were statistically significant (p < or = 0.001).


CONCLUSIONS
The combined PHI/MOI score was better at identifying those patients with ISS scores > or = 16 compared with the PHI and MOI scores alone. Although this permitted superior triage (and minimized overtriage), the combined score did not identify all major trauma patients.
Bond
R J
RJ
Department of Surgery, University of Calgary, Alberta, Canada.
Kortbeek
J B
JB
Preshaw
R M
RM
D000059:Accidents; D000293:Adolescent; D000328:Adult; D004632:Emergency Medical Services; D006801:Humans; D015601:Injury Severity Score; D011446:Prospective Studies; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D013177:Sports; D014218:Triage / Q000379:methods* / Q000592:standards; D014754:Violence; D014947:Wounds and Injuries / Q000145:classification* / Q000175:diagnosis / Q000209:etiology