title: Validation and refinement of a rule to predict emergency intervention in adult trauma patients.
abstract: OBJECTIVE
  Trauma centers use "secondary triage" to determine the necessity of trauma surgeon involvement. A clinical decision rule, which includes penetrating injury, an initial systolic blood pressure less than 100 mm Hg, or an initial pulse rate greater than 100 beats/min, was developed to predict which trauma patients require emergency operative intervention or emergency procedural intervention (cricothyroidotomy or thoracotomy) in the emergency department. Our goal was to validate this rule in an adult trauma population and to compare it with the American College of Surgeons' major resuscitation criteria.
  
  
  METHODS
  We used Level I trauma center registry data from September 1, 1995, through November 30, 2008. Outcomes were confirmed with blinded abstractors. Sensitivity, specificity, and 95% confidence intervals (CIs) were calculated.
  
  
  RESULTS
  Our patient sample included 20,872 individuals. The median Injury Severity Score was 9 (interquartile range 4 to 16), 15.3% of patients had penetrating injuries, 13.5% had a systolic blood pressure less than 100 mm Hg, and 32.5% had a pulse rate greater than 100 beats/min. Emergency operative intervention or procedural intervention was required in 1,099 patients (5.3%; 95% CI 5.0% to 5.6%). The sensitivities and specificities of the rule and the major resuscitation criteria for predicting emergency operative intervention or emergency procedural intervention were 95.6% (95% CI 94.3% to 96.8%) and 56.1% (95% CI 55.4% to 56.8%) and 85.5% (95% CI 83.3% to 87.5%) and 80.9% (95% CI 80.3% to 81.4%), respectively.
  
  
  CONCLUSIONS
  This new rule was more sensitive for predicting the need for emergency operative intervention or emergency procedural intervention directly compared with the American College of Surgeons' major resuscitation criteria, which may improve the effectiveness and efficiency of trauma triage.
authors.affiliation: Department of Emergency Medicine, Denver Health Medical Center, 777 Bannock Street, Denver, CO 80206, USA. Jason.Haukoos@dhha.org
authors.forename: Jason S
authors.initials: JS
authors.lastname: Haukoos
authors.forename: Richard L
authors.initials: RL
authors.lastname: Byyny
authors.forename: Catherine
authors.initials: C
authors.lastname: Erickson
authors.forename: Stephen
authors.initials: S
authors.lastname: Paulson
authors.forename: Emily
authors.initials: E
authors.lastname: Hopkins
authors.forename: Comilla
authors.initials: C
authors.lastname: Sasson
authors.forename: Brooke
authors.initials: B
authors.lastname: Bender
authors.forename: Craig S
authors.initials: CS
authors.lastname: Gravitz
authors.forename: Jody A
authors.initials: JA
authors.lastname: Vogel
authors.forename: Christopher B
authors.initials: CB
authors.lastname: Colwell
authors.forename: Ernest E
authors.initials: EE
authors.lastname: Moore
mesh_terms: D000328:Adult; D001794:Blood Pressure; D004636:Emergency Service, Hospital; D006801:Humans; D015601:Injury Severity Score; D016013:Likelihood Functions; D008297:Male; D008875:Middle Aged; D011674:Pulse; D012151:Resuscitation / Q000592:standards / Q000706:statistics & numerical data; D012189:Retrospective Studies; D012680:Sensitivity and Specificity; D016896:Treatment Outcome; D014218:Triage / Q000379:methods* / Q000592:standards; D014947:Wounds and Injuries / Q000601:surgery* / Q000628:therapy; D014950:Wounds, Penetrating / Q000601:surgery; D055815:Young Adult