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Prehospital Index: a scoring system for field triage of trauma victims
Insights
The Prehospital Index (PHI) is a reliable trauma severity score for prehospital triage. This scoring system accurately identifies major trauma patients likely to require surgery or experience mortality.
Area of Science:
- Emergency Medicine
- Trauma Surgery
- Prehospital Care
Background:
- The Prehospital Index (PHI) is a triage tool designed to assess trauma severity.
- It comprises four components: systolic blood pressure, pulse, respiratory status, and level of consciousness.
Purpose of the Study:
- To evaluate the effectiveness of the PHI in distinguishing between minor and major trauma patients.
- To assess the PHI's ability to predict mortality and the need for emergency operative intervention.
Main Methods:
- The PHI was developed using retrospective analysis of 313 trauma cases.
- Further retrospective analysis of 465 cases and prospective application to 388 cases were conducted.
- Patients were categorized as minor trauma (PHI 0-3) or major trauma (PHI 4-20).
Main Results:
- Retrospective analysis showed 0% mortality for minor trauma and 16.4% for major trauma.
- Prospective analysis revealed 0% mortality for minor trauma and 27% for major trauma.
- The PHI demonstrated significant predictive ability for mortality and operative intervention (P < .001).
Conclusions:
- The Prehospital Index is an effective tool for prehospital trauma triage.
- PHI scores accurately predict patient outcomes, including mortality and surgical needs.
- The PHI aids in objective decision-making for emergency medical services.
Abstract:
The Prehospital Index (PHI) is a triage-oriented trauma severity scoring system comprising four components: systolic blood pressure, pulse, respiratory status, and level of consciousness, each scored 0 to 5. The PHI was developed after analysis of 313 cases to provide an objective prehospital scoring system for distinguishing less seriously injured patients (minor trauma) from those patients who are likely to die within 72 hours after injury or who require general or neurosurgical operative intervention within 24 hours (major trauma). A PHI of 0 to 3 indicated minor trauma, and a PHI of 4 to 20 signified major trauma. Retrospective analysis of an additional 465 consecutive trauma cases revealed that patients with a PHI of 0 to 3 (minor trauma) had a 0% mortality and a 2% rate of general or neurosurgical operative intervention. Those with a PHI of 4 to 20 (major trauma) carried a 16.4% mortality and an emergency operative rate of 49.1%. The PHI was applied prospectively to 388 consecutive trauma cases presenting to the Butterworth Hospital Emergency Department from October through December 1984. Of the 351 patients scored as minor trauma in the field, there was a 0% mortality and only a 0.3% operative rate. Those scored as major trauma in the field had a mortality of 27% (PHI 4 to 7, 0%; PHI 8 to 20, 53%) and an operative rate of 40.5% (PHI 4 to 7, 22%; PHI 8 to 20, 57.9%). These data demonstrate the ability of the PHI to predict mortality (P less than .001) and the need for emergency general or neurosurgical operative intervention (P less than .001).(ABSTRACT TRUNCATED AT 250 WORDS)