Gray A, Goyder E C, Goodacre S W, Johnson G S
Accident and Emergency Department, St James's University Hospital, Leeds, UK.
Injury. 1997 Mar;28(2):97-101. doi: 10.1016/s0020-1383(96)00170-2.
The CRAMS scale and the Triage Revised Trauma Score (TRTS) were compared to assess their potential use as a prehospital method of activating hospital trauma teams. We studied patients from the resuscitation room of Leeds General Infirmary who had enough data recorded to allow calculation of the admission TRTS and CRAMS scale. Patients were defined as having major injury if they died in hospital, were admitted to the ICU or had an Injury Severity Score (ISS) of > 15. Each triage scale was compared by calculating multiple sensitivity/specificity pairs and plotting the results on a receiver operator (ROC) curve. The optimal cut-offs on each scale were compared directly. Ninety-seven (46 per cent) of a total of 213 patients fulfilled the study criteria for major injury. The best cut-off points were a CRAMS of < 9 and a TRTS of < 12. The TRTS was significantly more specific (0.9 versus 0.75) but at a cost of poor sensitivity (0.6 versus 0.69, not significant). The performance of both scales was similar when compared on the ROC curve. CRAMS and the TRTS were unable to identify major injuries in our sample with sensitivity and specificity adequate to support their use as a tool to activate trauma teams in the UK.
比较CRAMS量表和修订创伤分诊评分（TRTS），以评估它们作为院前启动医院创伤团队方法的潜在用途。我们研究了利兹总医院复苏室的患者，这些患者有足够的数据记录，可用于计算入院时的TRTS和CRAMS量表。如果患者在医院死亡、入住重症监护病房（ICU）或损伤严重度评分（ISS）>15，则定义为重伤。通过计算多个敏感度/特异度对并将结果绘制在受试者工作特征（ROC）曲线上，对每个分诊量表进行比较。直接比较每个量表的最佳截断值。213例患者中，97例（46%）符合重伤研究标准。最佳截断点为CRAMS<9和TRTS<12。TRTS的特异度显著更高（0.9对0.75），但敏感度较低（0.6对0.69，无显著差异）。在ROC曲线上比较时，两个量表的表现相似。在我们的样本中，CRAMS和TRTS无法以足够的敏感度和特异度识别重伤，不足以支持它们作为英国启动创伤团队工具的使用。
