Prehospital physiologic data and lifesaving interventions in trauma patients.
Background: The ability to accurately triage trauma patients can be difficult in the prehospital environment. Prehospital trauma scoring systems have been developed with a goal of determining which patients should be transported immediately to a trauma center, thus benefiting from critical personnel...
| Publicado en: | Military Medicine Vol. 170; no. 1; pp. 7 - 14 |
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| Autores principales: | , , , , , , , , , , , |
| Formato: | research tables/charts Journal Article |
| Publicado: |
Oxford University Press / USA
Jan2005
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| Acceso en línea: | Ver este registro en EBSCOhost |
| fields | @attributes: recordID: 1 pdfLink: plink: https://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=106612360&site=ehost-live header: @attributes: shortDbName: ccm uiTerm: 106612360 longDbName: CINAHL Complete uiTag: AN controlInfo: bkinfo: dissinfo: jinfo: jid: 00264075 4DV jtl: Military Medicine issn: 00264075 maglogo: N pubinfo: dt: Jan2005 vid: 170 iid: 1 pid: 622 pub: Oxford University Press / USA artinfo: ui: 106612360 106612360 NLM15724847 2005074138 10.7205/milmed.170.1.7 NLM15724847 106612360 ppf: 7 ppct: 7 formats: fmt: @attributes: type: P tig: atl: Prehospital physiologic data and lifesaving interventions in trauma patients. aug: au: Holcomb JB Niles SE Miller CC Hinds D Duke JH Moore FA Holcomb, John B Niles, Sarah E Miller, Charles C Hinds, Denise Duke, James H Moore, Frederick A affil: University of Texas Health Sciences Center, Houston, TX 77030, USA sug: subj: Aeromedical Transport Standards Decision Making Triage Methods Wounds and Injuries Diagnosis Adolescence Adult Aged Aged, 80 and Over Aircraft Chi Square Test Child Child, Preschool Convenience Sample Descriptive Statistics Female Funding Source Glasgow Coma Scale Hospitals, Urban Life Support Care Standards Life Support Care Utilization Logistic Regression Male Middle Age Null Hypothesis Odds Ratio Physical Examination Prospective Studies Random Sample ROC Curve Sensitivity and Specificity Severity of Injury Statistical Significance T-Tests Texas Time Factors Transportation of Patients Standards Transportation of Patients Utilization Triage Standards Wilcoxon Rank Sum Test Human Adolescent: 13-18 years Adult: 19-44 years Aged: 65+ years Aged, 80 & over Child: 6-12 years Child, Preschool: 2-5 years Middle Aged: 45-64 years Female Male ab: Background: The ability to accurately triage trauma patients can be difficult in the prehospital environment. Prehospital trauma scoring systems have been developed with a goal of determining which patients should be transported immediately to a trauma center, thus benefiting from critical personnel and resource-intensive lifesaving interventions (LSIs). A resource-based endpoint, LSIs, therefore might be the optimal endpoint of prehospital triage scoring and could be used to determine where patients are transported. We hypothesized that simple physiologic data available immediately upon scene arrival would prove predictive of the need for a LSI.Methods: Trauma patients transported from the injury scene by helicopter were eligible for entry into the study. Prehospital physiologic data and interventions were timed and recorded by flight medical personnel, whereas hospital vital signs, injuries, and interventions were prospectively recorded from the inpatient records. The motor component of the Glasgow Coma Scale was used as an indicator of neurologic function. LSIs were procedures deemed lifesaving by a multidisciplinary panel of trauma experts.Results: Physiologic data were collected from August 2001 to February 2002. Data were collected for 216 random patients transported by the Life Flight helicopter service. There were no differences between LSI and non-LSI patients in age, gender, or transport time, and 80 patients underwent 197 LSIs. The mean age was 33 +/- 17 years, 73% of patients were male, 90% suffered blunt injury, the injury severity score was 14 +/- 9, hypotension (systolic blood pressure of < 90 mm Hg) was present in 14% of cases, and the mortality rate was 6%. Penetrating injury and increasing injury severity score were associated with LSI. Univariate analysis of the physiologic data immediately available in the field revealed that SBP of < 90 mm Hg, motor score of < 6, delayed capillary refill, and increasing pulse were significantly associated with a LSI. However, multivariate analysis revealed that only SBP of < 90 mm Hg and motor score of < 6 were associated with a LSI. When both variables were abnormal, 95% of patients required a LSI; when both variables were normal, 21% of patients required a LSI.Conclusions: The presence of hypotension or decreased motor score was correlated with the need for LSIs. However, normotensive patients with normal motor scores still frequently required LSIs. Optimal discrimination of this group of patients will require new analytic approaches. pubtype: Academic Journal doctype: research tables/charts Journal Article ougenre: Article language: English refInfo: holdings: @attributes: islocal: N |
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