title: Motor vehicle crash severity estimations by physicians and prehospital personnel.
abstract: OBJECTIVE
  To determine whether emergency physicians (EPs) and prehospital emergency medical services (EMS) personnel differ in their assessment of motor vehicle crash (MVC) severity and the potential for serious injury when viewing crash scene photographs.
  
  
  METHODS
  Attending and resident EPs, paramedics, and emergency medical technicians (EMTs) from a single emergency medicine system used a web-based survey platform to rate the severity of 100 crash photographs on a 10-point Likert scale (Crash Score) and the potential for serious injury on a 0-100% scale (Injury Score). Serious injury was defined as skull fracture or intracranial bleeding, spine fracture or spinal cord injury, intrathoracic or intraabdominal injury, or long bone fracture. Crash and Injury Scores were stratified into EP and paramedic/EMT (EMS) groups and the mean score was calculated for each photo. Spearman rank correlation coefficients with 95% confidence intervals (95% CI) and Bland-Altman plots were constructed to assess agreement. Secondary analyses were performed after categorizing data into quartiles based on participants' estimations of MVC severity.
  
  
  RESULTS
  A total of 54 attending and 53 resident EPs, 156 paramedics, and 34 EMTs were invited to participate in the survey. Of these, 39 (72%) attending and 46 (87%) resident EPs, 107 (69%) paramedics, and 17 (50%) EMTs completed the survey. A total of 183 (88%) surveys were completed in full. The overall Crash Score correlation coefficient between EPs and EMS was 0.98 (95% CI, 0.97-0.99). The Crash Score correlation coefficients for each quartile were 0.86 (0.57-0.97), 0.93 (0.85-0.96), 0.58 (0.16-0.85), and 0.88 (0.66-0.97), respectively. The overall Injury Score correlation coefficient between EPs and EMS was 0.98 (0.88-0.97). The Injury Score correlation coefficients for each quartile were 0.94 (0.48-0.91), 0.76 (0.50-0.92), 0.80 (0.69-1.00), and 0.94 (0.57-0.97), respectively.
  
  
  CONCLUSIONS
  Although overall agreement between EPs and EMS personnel was excellent, differences in estimation of crash severity and potential for injury were identified among crashes estimated to be moderate in severity.
authors.forename: Nathan
authors.initials: N
authors.lastname: Cleveland
authors.forename: Christopher
authors.initials: C
authors.lastname: Colwell
authors.forename: Erica
authors.initials: E
authors.lastname: Douglass
authors.forename: Emily
authors.initials: E
authors.lastname: Hopkins
authors.forename: Jason S
authors.initials: JS
authors.lastname: Haukoos
mesh_terms: D000063:Accidents, Traffic; D000328:Adult; D000368:Aged; D000488:Allied Health Personnel; D002983:Clinical Competence; D003120:Colorado; D016001:Confidence Intervals; D003430:Cross-Sectional Studies; D004632:Emergency Medical Services / Q000379:methods* / Q000706:statistics & numerical data; D004634:Emergency Medical Technicians; D004636:Emergency Service, Hospital; D005260:Female; D006801:Humans; D015601:Injury Severity Score; D008297:Male; D008505:Medical Staff, Hospital; D008875:Middle Aged; D018986:Motor Vehicles; D009104:Multiple Trauma / Q000175:diagnosis / Q000453:epidemiology; D011446:Prospective Studies; D011786:Quality Control; D018570:Risk Assessment; D012680:Sensitivity and Specificity; D014947:Wounds and Injuries / Q000175:diagnosis* / Q000453:epidemiology; D055815:Young Adult
keywords: accidents; emergency medical services (EMS); motor vehicle; wounds and injuries