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Overview :
The American
College of Surgeons Committee on Trauma (ASC/COT) proposed clinical findings
useful to triage patients. Tinkoff and O’Connor validated the rules and
developed an equation to predict mortality. The latter two authors are from the
Christiana Health System in Newark, Delaware.
Triage
rules:
(1) low systolic
blood pressure (< 90 mm Hg)
(2) Glasgow coma
score (GCS) < 8
(3) airway
compromise requiring endotrachial intubation or a surgical
airway
(4) penetrating
gunshot wound (GSW) to head, neck, thorax or abdomen (head or
torso)
(5) transfer
from another hospital receiving blood to maintain vital
signs
(6) discretion
of ED physician
where:
• The abstract by Tinkoff and O’Connor
had a penetrating wound to the head or torso rather than a gunshot
wound.
Tinkoff and
O’Connor found that the first 4 criteria correlated with urgent surgery, ICU
admission and mortality. The logistic regression model for mortality was (with 0
if risk factor absent and 1 if present):
X
=
= (0.0912 *
(penetrating GSW)) + (2.2942 * (GCS)) + (1.8363 * (hypotension)) + (2.2768 *
(emergency airway)) – 4.98
probability of
mortality =
= 1 / (1 +
EXP((-1)*X))
| References: | |
American College of Surgeons Committee on
Trauma. Amendments to Resources for Optimal Care of the Injured Patient: 1999.
Chicago, Illinois. American College of Surgeons. 2000.
www.facs.org.
Tinkoff GH, O’Connor RE. Validation of
new trauma triage rules for trauma attending response to the Emergency
Department. J Trauma Injury Infeciton Critical Care. 2000; 49: 1171 (EAST
abstract)
Tinkoff GH, O’Connor RE. Validation of
the New Trauma Triage Rules for Trauma attending response to the Emergency
Deparatment. J Trauma Injury Infection Critical Care. 2002; 52:
1153-1159.
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