Accuracy of the Prehospital Index in identifying major hemorrhage in trauma victims.
OBJECTIVE
To determine the sensitivity of the Prehospital Index (PHI) in identifying patients with severe blood loss, a one-year review was conducted at a regional trauma facility.


METHODS
The study population consisted of 217 consecutive trauma admissions (ages 3 to 88 years).  Patients were managed using standard resuscitation techniques; blood transfusions were ordered at the discretion of attending physicians and did not follow any preplanned protocol.  Medical records were examined to determine total blood requirements for each patient during the first 12 hours of hospitalization, the emergency department (ED) disposition, and final outcome of treatment.  The following clinical variables were analyzed (unpaired t-test) to determine their value as predictors of blood loss: age, gender, mechanism of injury, initial vital signs, revised trauma score, PHI, and injury severity score.


RESULTS
Forty-two percent (92 patients) received transfusions during the first 12 hours of hospitalization.  The best predictor of blood loss was the Prehospital Index.  Of the total group, 45% had a PHI greater than 3; 77% (75/98) of these patients required transfusion and received an average of 7.1 units of packed cells.  Fifty-five percent (119/217) had a PHI less than or equal to 3; 86% (102/119) of these patients did not require transfusion.


CONCLUSIONS
The data suggest that patients with PHI scores greater than 3 require close hemodynamic monitoring to rule out significant blood loss and may warrant immediate cross-matching on arrival to the ED.
Emergency Medicine Residency Program and Trauma Registry, Butterworth Hospital, Michigan State University College of Human Medicine, Grand Rapids 49503.
J
J
Jones
C
C
Newman
J
J
Krohmer
C
C
Mattice
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001803:Blood Transfusion; D002648:Child; D002675:Child, Preschool; D004632:Emergency Medical Services; D005260:Female; D006470:Hemorrhage / Q000175:diagnosis*; D006801:Humans; D008297:Male; D008875:Middle Aged; D015599:Trauma Severity Indices