ORIGINAL CONTRIBUTION trauma; triage
The Trauma Triage Rule: A New, ResourceBased Approach to the Prehospital Identification of Major Trauma Victims Study objective: To develop a n e w trauma decision rule. Design: Retrospective clinical review. Setting: Level ! trauma center. Type of participants: 1,004 injured adults. Measurements and main results: A n e w trauma decision rule was de~ rived from 1,004 injured adult patients using a n e w operational definition of major trauma. The rule, termed the Trauma Triage Rule, defines a major trauma victim as any injured adult patient whose systolic blood pressure is less than 85 m m Hg; whose motor component of the Glasgow Coma Score is less than 5; or who has sustained penetrating trauma of the head, neck, or trunk. Using the operational definition of major trauma, the rule had a sensitivity of 92% and a specificity of 92% w.hen tested on the 1,O04-patient cohort. Conclusion: The Trauma Triage Rule m a y significantly reduce overtriage while only minimally increasing undertriage. This approach must be validated prospectively before it can be used in the prehospital setting. [Baxt WG, Jones G, Fortlage D: The trauma triage rule: A new,, resourcebased approach to the prehospital identification of major trauma victims. Ann Emerg Med December 1990;19:1401-1406.]
William G Baxt, MD* Gene Jones* Dale Fortlaget San Diego, California From the Departments of Emergency Medicine* and Surgery,t University of California, San Diego, Medical Center. Received for publication December 11, 1989. Revision received May 14, 1990. Accepted for publication June 22, 1990. Address for reprints: William G Baxt, MD, Department of Emergency Medicine, UCSD Medical Center, 225 Dickinson Street, H-665-A, San Diego, California 92103-1990.
INTRODUCTION Regionalized trauma systems have been slow to develop< 2 primarily because of their high cost. This cost is due to the extensive human and physical resources that must be allocated to such systems. One major determinant of the extent of these resources is the number of patients a trauma system has to service. This number is determined at the prehospital level by triage criteria that identify those patients who require evaluation and treatment at a trauma center. Different physiologic or anatomic and mechanistic criteria have been used to form the basis for various scoring systems designed to be predictive of major injury. Initially these scoring systems were thought to be predictive, 3-s but recent reports have provided evidence to the contrary.6, 7 The inaccuracy of one system was illustrated in a recent report that stated that to obtain a sensitivity of 95%, a specificity of 40% had to be accepted. 8 These problems appear to be inherent in all triage systems used to date. Recent analyses revealed that although all triage systems could accurately predict death, the best simultaneous sensitivity and specificity that could be obtained in predicting major injury was 70% and 70%, respectively. 9 These results were corroborated by another more recent study based on pediatric trauma patients, t° Because trauma is a disease of low incidence, l
The Trauma Triage Rule: A New, ResourceBased Approach to the Prehospital Identification of Major Trauma Victims Study objective: To develop a n e w trauma decision rule. Design: Retrospective clinical review. Setting: Level ! trauma center. Type of participants: 1,004 injured adults. Measurements and main results: A n e w trauma decision rule was de~ rived from 1,004 injured adult patients using a n e w operational definition of major trauma. The rule, termed the Trauma Triage Rule, defines a major trauma victim as any injured adult patient whose systolic blood pressure is less than 85 m m Hg; whose motor component of the Glasgow Coma Score is less than 5; or who has sustained penetrating trauma of the head, neck, or trunk. Using the operational definition of major trauma, the rule had a sensitivity of 92% and a specificity of 92% w.hen tested on the 1,O04-patient cohort. Conclusion: The Trauma Triage Rule m a y significantly reduce overtriage while only minimally increasing undertriage. This approach must be validated prospectively before it can be used in the prehospital setting. [Baxt WG, Jones G, Fortlage D: The trauma triage rule: A new,, resourcebased approach to the prehospital identification of major trauma victims. Ann Emerg Med December 1990;19:1401-1406.]
William G Baxt, MD* Gene Jones* Dale Fortlaget San Diego, California From the Departments of Emergency Medicine* and Surgery,t University of California, San Diego, Medical Center. Received for publication December 11, 1989. Revision received May 14, 1990. Accepted for publication June 22, 1990. Address for reprints: William G Baxt, MD, Department of Emergency Medicine, UCSD Medical Center, 225 Dickinson Street, H-665-A, San Diego, California 92103-1990.
INTRODUCTION Regionalized trauma systems have been slow to develop< 2 primarily because of their high cost. This cost is due to the extensive human and physical resources that must be allocated to such systems. One major determinant of the extent of these resources is the number of patients a trauma system has to service. This number is determined at the prehospital level by triage criteria that identify those patients who require evaluation and treatment at a trauma center. Different physiologic or anatomic and mechanistic criteria have been used to form the basis for various scoring systems designed to be predictive of major injury. Initially these scoring systems were thought to be predictive, 3-s but recent reports have provided evidence to the contrary.6, 7 The inaccuracy of one system was illustrated in a recent report that stated that to obtain a sensitivity of 95%, a specificity of 40% had to be accepted. 8 These problems appear to be inherent in all triage systems used to date. Recent analyses revealed that although all triage systems could accurately predict death, the best simultaneous sensitivity and specificity that could be obtained in predicting major injury was 70% and 70%, respectively. 9 These results were corroborated by another more recent study based on pediatric trauma patients, t° Because trauma is a disease of low incidence, l
