Do the American College of Surgeons' "major resuscitation" trauma triage criteria predict emergency operative management?
OBJECTIVE
We wish to assess whether individual or collective American College of Surgeons' "major resuscitation" criteria accurately identify injured patients who receive emergency operative treatment.


METHODS
In this observational secondary registry analysis of 8,289 consecutive trauma team activations during a 7.5-year period, we evaluated the test performance of 5 American College of Surgeons' major criteria in predicting emergency (within 1 hour) operative management by general (for adults) or pediatric (for children) surgeons.


RESULTS
In adults, the individual major resuscitation criteria each predicted emergency operative management as follows (sorted from highest to lowest test performance): gunshot wounds to the neck or torso (likelihood ratio positive [LR+] 7.5; 95% confidence interval [CI] 6.2 to 9.1); confirmed hypotension (LR+ 5.3; 95% CI 4.0 to 7.1); interhospital transfers requiring blood transfusions (LR+ 4.6; 95% CI 2.6 to 8.2); respiratory compromise (LR+ 2.9; 95% CI 2.2 to 3.7), and Glasgow Coma Scale score less than 8 (LR+ 2.1; 95% CI 1.6 to 2.7). The collective strategy of using any of these 5 criteria exhibited a LR+ of 3.5 (95% CI 3.2 to 3.8), sensitivity 82% (95% CI 75% to 87%), and specificity 76% (95% CI 75% to 77%). Our findings in children were similar, but their precision was limited by the low baseline prevalence of emergency operative intervention.


CONCLUSIONS
These 5 American College of Surgeons-mandated major resuscitation criteria vary several-fold in their individual ability to predict emergency operative management and collectively exhibit modest test characteristics for this purpose. Selective use of these criteria or revisions thereof could result in more efficient secondary trauma triage. Our results do not support the existing obligatory use of these criteria to maintain American College of Surgeons trauma center certification.
Steele
Robert
R
Department of Emergency Medicine, Loma Linda University Medical Center, Loma Linda, CA 92354, USA.
Gill
Michelle
M
Green
Steven M
SM
Parker
Travis
T
Lam
Eduardo
E
Coba
Victor
V
D000328:Adult; D001803:Blood Transfusion / Q000706:statistics & numerical data; D002648:Child; D015897:Comorbidity; D004635:Emergency Medicine / Q000592:standards* / Q000706:statistics & numerical data; D006801:Humans; D007022:Hypotension / Q000453:epidemiology / Q000601:surgery; D017410:Practice Guidelines as Topic; D011237:Predictive Value of Tests; D017064:Process Assessment, Health Care; D012042:Registries; D012151:Resuscitation / Q000592:standards* / Q000706:statistics & numerical data; D012955:Societies, Medical; D014218:Triage / Q000592:standards* / Q000706:statistics & numerical data; D014481:United States / Q000453:epidemiology; D014947:Wounds and Injuries / Q000145:classification* / Q000453:epidemiology / Q000601:surgery*; D014948:Wounds, Gunshot / Q000453:epidemiology / Q000601:surgery