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Assessment:
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Focused Assessment with Sonography for Trauma (FAST) Exam: Image Acquisition
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Published on: September 22, 2023

Does EMS perceived anatomic injury predict trauma center need?

E Brooke Lerner1, Jennifer Roberts, Clare E Guse

  • 1Medical College of Wisconsin, Milwaukee , WI 53226, USA. eblerner@mcw.edu

Prehospital Emergency Care
|May 1, 2013
PubMed
Summary

The anatomic criteria in the Field Triage Decision Scheme effectively identify trauma center needs, though pelvic fractures may require reevaluation. This study highlights the utility of EMS provider assessments in trauma care.

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Area of Science:

  • Emergency Medicine
  • Trauma Surgery
  • Public Health Policy

Background:

  • The 2011 Field Triage Decision Scheme guides emergency medical services (EMS) in determining the need for trauma center care.
  • The anatomic step of this scheme is crucial but requires validation for its predictive accuracy.

Purpose of the Study:

  • To evaluate the predictive value of the anatomic criteria within the 2011 Field Triage Decision Scheme for identifying patients requiring trauma center resources.
  • To assess the accuracy of EMS provider assessments of anatomic injuries in predicting trauma center need.

Main Methods:

  • Interviews with EMS providers were conducted over two years for injured adults transported to trauma centers.
  • Data collected included physiologic and anatomic injury information, with trauma center need defined by specific clinical outcomes.
  • Positive likelihood ratios (+LRs) with 95% confidence intervals (CIs) were calculated to assess predictive value.

Main Results:

  • Of 11,892 interviews, 1,167 met anatomic criteria, with 307 (26%) requiring trauma center resources (+LR 4.4).
  • Strong predictors of trauma center need included flail chest, paralysis, multiple long-bone fractures, and amputation (+LR ≥5).
  • Penetrating injuries and skull fractures also showed significant predictive value ( +LR >2 and <5), while pelvic fractures had limited predictive value (+LR 1.9).

Conclusions:

  • The anatomic step of the Field Triage Guidelines, as interpreted by EMS providers, is a valuable tool for directing patients to trauma centers.
  • The utility of identifying pelvic fractures for trauma center activation by EMS should be reconsidered.
  • Refining the anatomic criteria may improve the efficiency and accuracy of trauma triage.