Is mechanism of injury alone a useful predictor of major trauma?

The Review of Trauma and Emergency Services in Victoria -1999 left unresolved the predictive value of mechanism of injury in pre-hospital trauma triage guidelines. Ethics approval was granted. The objective of this study is to determine if mechanism of injury alone is a useful predictor of major trauma in pre-hospital trauma triage.

A retrospective cohort study was undertaken of all Victorian ambulance trauma Patient Care Records (PCRs) for 2002. PCRs where patients were physiologically stable, had no significant pattern of injury, but had a significant mechanism of injury were identified and compared with the State Trauma Registry to determine those patients who sustained hospital defined major trauma.

There were 4571 incidents of mechanism of injury only, of which 62% were males, median age was 28 years. Two criteria had statistically significant results. A fall from greater than 5m (n=52) of whom 5 (RR 10.86, CI 4.47 to 26.42, P<0.0001) sustained major trauma and a patient trapped greater than 30 min (n=36) of whom 3 (RR 9.0, CI 2.92 to 27.70, P=0003) sustained major trauma. The overall results are not clinically significant.

This study suggests that individual mechanism of injury criteria have no clinical or operational significance in pre-hospital trauma triage of patients who have an absence of physiological distress and no significant pattern of injury. These results add to the knowledge base of trauma presentation in the pre-hospital setting, especially in Australia, and are the baseline for further studies.