title: Should we still use motor vehicle intrusion as a sole triage criterion for the use of trauma center resources?
abstract: BACKGROUND
  Motor vehicle intrusion (MVI) is one of the field triage criteria recommended by the American College of Surgeons Committee of Trauma (ACS-COT) and Centers for Disease Control and Prevention (CDC). However, the evidence supporting its validity is scarce. The purpose of this study was to evaluate the validity of this criterion and assess its impact on overtriage or undertriage.
  
  
  METHODS
  This was a retrospective study based on the Los Angeles County Trauma and Emergency Medicine Information System (TEMIS) Trauma database. Included in the analysis were patients with MVI as the sole criterion for trauma center triage. Physiological characteristics, severity of injury, and outcomes of the MVI patients were compared between different age groups. Further, a logistic regression model was used to identify factors significantly associated with the need for trauma center resources.
  
  
  RESULTS
  During the period 2002-2012, a total of 10,554 trauma patients involved in motor vehicle crashes had documentation of MVI. A subgroup of 3998 patients (37.9%) did not meet any other criteria that require immediate transportation to a designated trauma center. Only 0.7% of these patients had hypotension and 0.1% had deterioration of the Glasgow Coma Scale on admission to the emergency room. Overall, 18.8% of patients required trauma center resources defined as intubation in the emergency room, certain surgical procedures, in-hospital death, or intensive care unit admission. Age ≥65 years, male gender, prehospital heart rate >100/min, and systolic blood pressure <110 mmHg were significantly associated with the need for trauma center resources.
  
  
  CONCLUSIONS
  The MVI itself did not appear to be a strong indicator for the use of trauma center resources and is associated with excessive overtriage. However, age >65 years, systolic blood pressure <110 mmHg, and heart rate >100/min were significant predictors for the need of trauma center resources. The MVI criterion should be refined for better utilization of trauma center resources.
authors.affiliation: Division of Acute Care Surgery, University of Southern California, Los Angeles, CA, USA. Electronic address: mkazu45@gmail.com.
authors.forename: Kazuhide
authors.initials: K
authors.lastname: Matsushima
authors.affiliation: Division of Acute Care Surgery, University of Southern California, Los Angeles, CA, USA.
authors.forename: Konstantinos
authors.initials: K
authors.lastname: Chouliaras
authors.affiliation: Emergency Medical Services Agency, Los Angeles County Department of Health Services, Santa Fe Springs, CA, USA.
authors.forename: William
authors.initials: W
authors.lastname: Koenig
authors.affiliation: Emergency Medical Services Agency, Los Angeles County Department of Health Services, Santa Fe Springs, CA, USA.
authors.forename: Christy
authors.initials: C
authors.lastname: Preston
authors.affiliation: Emergency Medical Services Agency, Los Angeles County Department of Health Services, Santa Fe Springs, CA, USA.
authors.forename: Deidre
authors.initials: D
authors.lastname: Gorospe
authors.affiliation: Division of Acute Care Surgery, University of Southern California, Los Angeles, CA, USA.
authors.forename: Demetrios
authors.initials: D
authors.lastname: Demetriades
mesh_terms: D000063:Accidents, Traffic / Q000706:statistics & numerical data; D001336:Automobiles; D002487:Centers for Disease Control and Prevention, U.S.; D004632:Emergency Medical Services; D015600:Glasgow Coma Scale; D006760:Hospitalization / Q000706:statistics & numerical data*; D006801:Humans; D015601:Injury Severity Score; D007362:Intensive Care Units; D016015:Logistic Models; D017410:Practice Guidelines as Topic; D012189:Retrospective Studies; D014193:Trauma Centers / Q000706:statistics & numerical data; D014218:Triage / Q000379:methods*; D014481:United States / Q000453:epidemiology
keywords: Motor vehicle intrusion; Prehospital; Trauma center; Triage criteria