Knudson P, Frecceri C A, DeLateur S A
Department of Trauma, San Jose Hospital, California 95112.
J Trauma. 1988 May;28(5):602-6. doi: 10.1097/00005373-198805000-00006.
The Trauma Scores, CRAMS scales, and mechanisms of injury of 500 trauma patients were evaluated for their ability to identify a seriously injured patient. Serious injury was defined as one of the following: Injury Severity Score (ISS) greater than 15, or emergency-room Trauma Score less than or equal to 14, or injuries requiring greater than 3 days hospitalization, or death. With the addition of specific mechanisms of injury (auto vs. pedestrian accident at greater than 5 m.p.h., motor vehicle accident at greater than 40 m.p.h., motorcycle accident at greater than 20 m.p.h., or a major assault), the sensitivity of a field Trauma Score of less than 14 could be improved from 45% to 75%, with a reasonable specificity of 40%. With these same mechanisms, the sensitivity of a CRAMS scale of less than or equal to 8 increased from 66% to 93%, with a specificity of 30%. The addition of these mechanisms of injury to standard field triage scoring appears to improve the identification of seriously injured patients while retaining an acceptable level of overtriage.
对500名创伤患者的创伤评分、CRAMS量表及损伤机制进行评估，以确定其识别重伤患者的能力。重伤定义如下：损伤严重度评分（ISS）大于15，或急诊室创伤评分小于或等于14，或需住院3天以上的损伤，或死亡。加上特定的损伤机制（时速大于5英里的汽车与行人事故、时速大于40英里的机动车事故、时速大于20英里的摩托车事故或重大袭击），现场创伤评分小于14的敏感性可从45%提高到75%，特异性为合理的40%。采用相同的损伤机制，CRAMS量表小于或等于8的敏感性从66%提高到93%，特异性为30%。在标准现场分诊评分中加入这些损伤机制似乎能改善对重伤患者的识别，同时保持可接受的过度分诊水平。
