Improving the Field Triage of Major Trauma Victims

Publisher Website
Google Scholar
Abstract
The Trauma Scores, CRAMS scales, and mechanisms of injury of 500 trauma patients were evaluated for their ability to identify a seriously injured patient. Serious injury was defined as one of the following: Injury Severity Score (ISS) > 15, or emergency-room Trauma Score .ltoreq. 14, or injuries requiring > 3 days hospitalization, or death. With the addition of specific mechanisms of injury (auto vs. pedestrian accident at > 5 m.p.h., motor vehicle accident at > 40 m.p.h., motorcycle accident at > 20 m.p.h., or a major assault), the sensitivity of a field Trauma Score of < 14 could be improved from 45% to 75%, with a reasonable specificity of 40%. With these same mechanisms, the sensitivity of a CRAMS scale of .ltoreq. 8 increased from 66% to 93%, with a specificity of 30%. The addition of these mechanisms of injury to standard field triage scoring appears to improve the identification of seriously injured patients while retaining an acceptable level of overtriage.