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Prehospital physiologic data and lifesaving interventions in trauma patients
John B Holcomb1, Sarah E Niles, Charles C Miller
1University of Texas Health Sciences Center, Houston, TX 77030, USA. John.Holcomb@amedd.army.mil
Military Medicine
|February 24, 2005
Summary
Prehospital trauma scoring can predict the need for lifesaving interventions (LSIs). Hypotension and low motor scores are key indicators, but new methods are needed to identify all patients requiring LSIs.
Area of Science:
- Emergency Medicine
- Trauma Surgery
- Prehospital Care
Background:
- Accurate prehospital trauma patient triage is challenging.
- Prehospital trauma scoring systems aim to identify patients needing immediate trauma center transport and lifesaving interventions (LSIs).
- LSIs, as a resource-based endpoint, may be optimal for prehospital triage scoring.
Purpose of the Study:
- To determine if simple physiologic data available upon scene arrival can predict the need for LSIs.
- To evaluate the predictive value of prehospital data for LSI requirement.
Main Methods:
- Eligible patients were trauma cases transported by helicopter.
- Prehospital physiologic data and interventions were recorded by flight medical personnel.
- Hospital vital signs, injuries, and interventions were recorded from inpatient records; motor component of Glasgow Coma Scale and LSIs (defined by experts) were used.
Main Results:
- Data from 216 patients showed 80 underwent 197 LSIs.
- Multivariate analysis identified systolic blood pressure < 90 mm Hg and motor score < 6 as significant predictors of LSI.
- When both SBP < 90 mm Hg and motor score < 6 were abnormal, 95% of patients required LSIs; when both were normal, 21% required LSIs.
Conclusions:
- Hypotension and decreased motor score correlate with LSI need.
- Normotensive patients with normal motor scores frequently required LSIs, indicating limitations in current prediction.
- New analytic approaches are necessary for optimal discrimination of patients requiring LSIs.