|
Overview :
Bond et al
combined the prehospital index (PHI) and mechanism of injury (MOI) for field
triage of trauma patients. The authors are from the University of
Calgary.
Parameters:
(1) prehospital
index (PHI, described above)
(2) type of
trauma
Prehospital
Index (without penetrating injury, maximal score 20
points)
|
Parameter |
Finding |
Points |
|
systolic
blood pressure |
> 100
mm Hg |
0 |
|
|
86-100 mm
Hg |
1 |
|
|
75-85 mm
Hg |
2 |
|
|
0-74 mm
Hg |
5 |
|
pulse |
51-119
beats per minute |
0 |
|
|
>= 120
beats per minute |
3 |
|
|
<= 50
beats per minute |
5 |
|
respirations |
normal |
0 |
|
|
shallow
and/or labored |
3 |
|
|
< 10
per minutes, or intubated |
5 |
|
consciousness |
normal |
0 |
|
|
confused
and/or combative |
3 |
|
|
no
intelligible words |
5 |
where:
• It would be interesting to see if the
use of penetrating trauma would improve performance.
|
Parameter |
Finding |
Points |
|
prehospital
index |
0 to
3 |
0 |
|
|
>=
4 |
1 |
|
type of
trauma |
motor
vehicle crash with death or serious injury to another occupant of the same
car |
1 |
|
|
motor
vehicle crash with steering wheel deformity |
1 |
|
|
motor
vehicle crash with structural intrusion into the passenger compartment
> 20 inches |
1 |
|
|
fall >
15 feet |
1 |
|
|
fall with
head involvement |
1 |
|
|
fall down
a staircase |
1 |
|
|
motorcycle
crash with victim ejected at > 30 km/h (> 18.6
miles/h) |
1 |
|
|
pedestrian
struck at a velocity > 15 km/h (> 9.3
miles/h) |
1 |
|
|
none of
the above |
0 |
combined score
=
= SUM(points for
all of the features present)
Interpretation:
• minimum score:
0
• maximum score:
3 or more
• A combined
score >= 1 indicates major trauma (ISS >= 16).
Performance:
• The sensitivity of the PHI alone was
41% with specificity of 98%.
• The sensitivity of the mechanism of
injury alone was 73% with specificity of 91%.
• The sensitivity of the combined score
was 78% with specificity of 89%. The negative predictive value is 99%.
Overtriage was reduced.
Limitation:
• The combined
score did not identify all major trauma patients.
| References: | |
Bond RJ, Kortbeek JB, et al. Field trauma
triage: Combining mechanism of injury with the prehospital index for an improved
trauma triage tool. J Trauma Injury Infection Critical Care. 1997; 43:
283-287.
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