Do Mechanism-of-Injury Triage Criteria Predict Need for Trauma Center?
Some currently used criteria, including vehicle rollover and motor vehicle crash speed >40 mph, are poor predictors.
Only anatomical and physiological criteria are validated indications for transport to a trauma center, but many systems also use mechanism of injury (MOI) criteria, which are largely based on expert consensus opinion. In a prospective observational 2-year study, investigators assessed the predictive value of MOI criteria in a convenience sample of 9483 adults who presented to three level I regional trauma centers directly from the scene of injury and who did not meet physiological or anatomical criteria. The trauma centers were primary receiving centers for patients with traumatic injuries, regardless of whether they met criteria for trauma-center transport.
Of 2363 patients who were transported to a trauma center on the basis of MOI criteria, 204 (9%) were considered in retrospect to need a trauma center (defined as nonorthopedic surgery within 24 hours, intensive care unit admission, or in-hospital death). Of the 7120 patients who did not meet MOI criteria, 310 (4%) were considered to need a trauma center. Death of another vehicle occupant, fall >20 feet, and motor vehicle crash (MVC) extrication time >20 minutes were good predictors of need for trauma center (positive likelihood ratio >5); intrusion >12 inches, ejection from a vehicle, and vehicle deformity >20 inches were moderate predictors (LRs 2–5); and MVC at >40 mph, motorcycle crash at >20 mph, vehicle rollover, rider separated from motorcycle, and pedestrian or bicyclist thrown, run over, or struck at speed >5 mph were poor predictors of need for trauma center (LR ≤2).
Comment: Use of mechanism-of-injury criteria alone results in dramatic overtriage to trauma centers. Systems should rely on validated physiological and anatomical criteria to determine transport destination for trauma patients. For patients who do not meet physiological or anatomical criteria, death of another vehicle occupant, fall >20 feet, and extrication time >20 minutes might predict need for trauma center.
Kristi L. Koenig, MD, FACEP
Published in Journal Watch Emergency Medicine September 23, 2011
Citation(s): Lerner EB et al. Does mechanism of injury predict trauma center need? Prehosp Emerg Care 2011 Oct/Dec; 15:518.