Trauma triage: do AAMS transport guidelines do it effectively?
OBJECTIVE
Appropriateness of helicopter transport for trauma patient transfer is under closer scrutiny with the development of regionalized trauma systems and managed care. This study was conducted to determine the effectiveness of the 14 Association of Air Medical Services (AAMS) guidelines in triaging trauma patients.


METHODS
The application of the trauma transport guidelines for 511 patients flown to our trauma center with hospital stays of fewer than 3 days were analyzed to ensure high sensitivity to overtriage. Injury severity score (ISS), revised trauma score (RTS), Glasgow coma scale (GCS), and mortality rates associated with each of the guidelines were analyzed.


RESULTS
Each guideline was associated with mortality greater than or equal to 20%, except motor vehicle, falls, amputation, and degloving. All guidelines had significant ISS (> 14), RTS (< 10), and GCS (< 12), except falls (ISS-6.7, RTS-11, GCS-13.3) and amputations (ISS-6.3, RTS-11, GCS-13.5). Degloving, motor vehicle, spinal cord, airway, and extrication also had a significantly higher RTS (> 12).


CONCLUSIONS
The AAMS transport guidelines for trauma patients accurately predict the potential for serious or life-threatening injury, with the exception of falls and amputations. The rapid access to highly skilled reimplantation teams required by patients with amputations justifies helicopter transport. However, falls greater than 20 feet do not appear to identify potential for life-threatening injury.
Bamoski
A
A
MetroHealth Medical Center, Cleveland, OH 44109, USA.
Kovach
B
B
Podmore
M
M
Pastis
E
E
Fallon
W F
WF
D000328:Adult; D017732:Air Ambulances / Q000592:standards*; D005069:Evaluation Studies as Topic; D006801:Humans; D009820:Ohio / Q000453:epidemiology; D017410:Practice Guidelines as Topic; D012952:Societies; D014187:Transportation of Patients / Q000592:standards* / Q000706:statistics & numerical data; D015599:Trauma Severity Indices; D014218:Triage / Q000458:organization & administration / Q000592:standards*; D014947:Wounds and Injuries / Q000145:classification* / Q000401:mortality