PARAMEDIC INJURY SEVERITY PERCEPTION CAN AID TRAUMA TRIAGE

Study objective: To compare information contained in standard out-of-hospital trauma triage criteria and standard criteria plus advanced emergency medical technician (EMT) injury severity perception for determination of patient need for trauma center evaluation. Design: Prospective, observational cohort analysis of trauma triage by advanced EMTs. Participants: Out-of-hospital, geographically stratified statewide sample of patients injured in Oregon. Results: Advanced EMTs provided patient information on demographics, physiologic parameters, injury anatomy and mechanism, premorbid conditions, EMT injury severity perception, and trauma system entry status. A four-point scale was used to grade the injury severity perception. Need for trauma center evaluation was defined as major surgery within 6 hours of hospital arrival, admission to the ICU, death in the hospital, or Injury Severity Scale score of 16 or more. The relative triage information gain with injury severity perception was assessed by use of logistic regression, tree-based models, and receiver operating characteristic (ROC) curves. Of 1,063 patients, 307 (28.9%) warranted trauma center evaluation. With logistic regression modeling, the following standard triage parameters were associated (P<.05) with the need for trauma center evaluation after inclusion of injury severity perception: systolic blood pressure less than 90 mm Hg, abnormal respiratory rate (less than 10 or more than 29), Glasgow Coma Scale score less than 13, penetrating injury (midthigh to head), two or more obvious proximal longbone fractures, and fall of more than 20 feet. The two largest injury severity perception categories had the greatest odds ratios (20:1 and 167:1). ROC curve areas improved with injury severity perception (.88 versus .83 without; P<.0001). Conclusion: Standard out-of-hospital triage criteria benefit from inclusion of advanced EMT injury severity perception information.