Henry M C, Hollander J E, Alicandro J M, Cassara G, O'Malley S, Thode H C
State University of New York at Stony Brook, University Medical Center 11794-7400, USA.
Acad Emerg Med. 1996 Nov;3(11):992-1000. doi: 10.1111/j.1553-2712.1996.tb03340.x.
To determine the incremental benefit of individual American College of Surgeons (ACS) trauma triage criteria for prediction of severe injuries after consideration of concurrent physiologic, anatomic, mechanism, or "other" criteria.
A prospective cross-sectional study of motor vehicle crash victims transported to any of the 12 hospitals in a suburban/rural county by local ambulance services was performed. Demographic and individual ACS criteria were collected using structured data instruments. EDs provided patient disposition within 24 hours of patient arrival. Medical records were reviewed. Major outcomes were admission, operative interventions (OR), major nonorthopedic operative interventions or death (Maj-OR), and injury severity score (ISS). To optimize sensitivity and specificity of out-of-hospital triage decision rules, receiver operating characteristic (ROC) curves were derived.
Of 1,545 patients, 13% were admitted; 6% had OR; 1% had Maj-OR; and 3% had ISSs > or = 16. For all outcomes, the most useful criteria were physiologic and anatomic. Some additional criteria (crash speed > 20 mph, > or = 30-inch vehicle deformity, axle displacement) substantially worsened specificity, with minimal or no improvement in sensitivity. For example, the optimal ROC curve for Maj-OR was determined by a systolic blood pressure < 90 mm Hg, Glasgow Coma Scale (GCS) score < 13, respiratory rate (RR) < 10 or > 29, death of a same-car occupant, penetrating injury, and/or > or = 24-inch opposite-side compartment intrusion (sensitivity, 85%; specificity, 87%). An ISS > or = 16 was predicted by GCS score < 13, RR < 10 or > 29, penetrating injury, 2 proximal long bone fractures, flail chest, > or = 24-inch opposite-side compartment intrusion, patient ejection, rollover, and/or age < 5 or > 55 years (sensitivity, 86%; specificity, 70%).
Physiologic and anatomic trauma triage criteria predicted increased hospital resource utilization and severe injury. On the other hand, when used concurrently with physiologic, anatomic, and "other" criteria, some mechanism criteria worsen specificity with negligible improvement in sensitivity. In particular, crash speed > 20 mph and > or = 30-inch vehicle deformity had little predictive value for all outcomes.
在综合考虑同时存在的生理、解剖、机制或“其他”标准后，确定美国外科医师学会（ACS）个体创伤分诊标准对预测严重损伤的增量效益。
对由当地救护车转运至一个郊区/农村县的12家医院中任何一家的机动车碰撞受害者进行前瞻性横断面研究。使用结构化数据工具收集人口统计学和个体ACS标准。急诊科在患者到达后24小时内提供患者处置情况。对病历进行审查。主要结局包括入院、手术干预（OR）、主要非骨科手术干预或死亡（Maj-OR）以及损伤严重度评分（ISS）。为优化院外分诊决策规则的敏感性和特异性，绘制了受试者工作特征（ROC）曲线。
在1545例患者中，13%入院；6%接受手术；1%接受主要非骨科手术或死亡；3%的ISS≥16。对于所有结局，最有用的标准是生理和解剖标准。一些其他标准（碰撞速度>20英里/小时、车辆变形≥30英寸、车轴移位）显著降低了特异性，而敏感性改善最小或无改善。例如，Maj-OR的最佳ROC曲线由收缩压<90mmHg、格拉斯哥昏迷量表（GCS）评分<13、呼吸频率（RR）<10或>29、同车乘客死亡、穿透伤和/或对侧车厢侵入≥24英寸确定（敏感性85%；特异性87%）。ISS≥16由GCS评分<13、RR<10或>29、穿透伤、2处近端长骨骨折、连枷胸、对侧车厢侵入≥24英寸、患者弹出、翻车和/或年龄<5岁或>55岁预测（敏感性86%；特异性70%）。
生理和解剖创伤分诊标准可预测医院资源利用增加和严重损伤。另一方面，当与生理、解剖和“其他”标准同时使用时，一些机制标准会降低特异性，而敏感性改善可忽略不计。特别是，碰撞速度>20英里/小时和车辆变形≥30英寸对所有结局的预测价值很小。
