Wasserman Erin B, Shah Manish N, Jones Courtney M C, Cushman Jeremy T, Caterino Jeffrey M, Bazarian Jeffrey J, Gillespie Suzanne M, Cheng Julius D, Dozier Ann
Prehosp Emerg Care. 2015 Apr-Jun;19(2):202-12. doi: 10.3109/10903127.2014.959225. Epub 2014 Oct 7.
We sought to identify a scale or components of a scale that optimize detection of older adult traumatic brain injury (TBI) patients who require transport to a trauma center, regardless of mechanism.
We assembled a consensus panel consisting of nine experts in geriatric emergency medicine, prehospital medicine, trauma surgery, geriatric medicine, and TBI, as well as prehospital providers, to evaluate the existing scales used to identify TBI. We reviewed the relevant literature and solicited group feedback to create a list of candidate scales and criteria for evaluation. Using the nominal group technique, scales were evaluated by the expert panel through an iterative process until consensus was achieved.
We identified 15 scales for evaluation. The panel's criteria for rating the scales included ease of administration, prehospital familiarity with scale components, feasibility of use with older adults, time to administer, and strength of evidence for their performance in the prehospital setting. After review and discussion of aggregated ratings, the panel identified the Simplified Motor Scale, GCS-Motor Component, and AVPU (alert, voice, pain, unresponsive) as the strongest scales, but determined that none meet all EMS provider and patient needs due to poor usability and lack of supportive evidence. The panel proposed that a dichotomized decision scheme that includes domains of the top-rated scales -level of alertness (alert vs. not alert) and motor function (obeys commands vs. does not obey) -may be more effective in identifying older adult TBI patients who require transport to a trauma center in the prehospital setting.
Existing scales to identify TBI are inadequate to detect older adult TBI patients who require transport to a trauma center. A new algorithm, derived from elements of previously established scales, has the potential to guide prehospital providers in improving the triage of older adult TBI patients, but needs further evaluation prior to use.
我们试图确定一种量表或量表的组成部分，以优化对需要转运至创伤中心的老年创伤性脑损伤（TBI）患者的检测，无论其受伤机制如何。
我们组建了一个共识小组，成员包括老年急诊医学、院前急救医学、创伤外科、老年医学和TBI领域的九位专家以及院前急救人员，以评估用于识别TBI的现有量表。我们查阅了相关文献并征求了小组反馈，以创建候选量表和评估标准清单。使用名义群体技术，专家小组通过迭代过程对量表进行评估，直至达成共识。
我们确定了15个用于评估的量表。小组对量表进行评分的标准包括易于实施、院前急救人员对量表组成部分的熟悉程度、对老年人使用的可行性、实施时间以及其在院前环境中表现的证据强度。在对汇总评分进行审查和讨论后，小组确定简化运动量表、格拉斯哥昏迷量表运动部分和AVPU（清醒、对声音有反应、对疼痛有反应、无反应）是最强的量表，但由于可用性差和缺乏支持性证据，确定没有一个量表能满足所有急救医疗服务提供者和患者的需求。小组建议，一种二分决策方案，包括排名靠前的量表的领域——警觉水平（清醒与不清醒）和运动功能（服从指令与不服从）——可能在识别院前环境中需要转运至创伤中心的老年TBI患者方面更有效。
现有的用于识别TBI的量表不足以检测需要转运至创伤中心的老年TBI患者。一种源自先前已建立量表要素的新算法有可能指导院前急救人员改善对老年TBI患者的分诊，但在使用前需要进一步评估。
