Kazuhide Matsushima1, Konstantinos Chouliaras2, William Koenig3, Christy Preston3, Deidre Gorospe3, Demetrios Demetriades2. 1. Division of Acute Care Surgery, University of Southern California, Los Angeles, CA, USA. Electronic address: mkazu45@gmail.com. 2. Division of Acute Care Surgery, University of Southern California, Los Angeles, CA, USA. 3. Emergency Medical Services Agency, Los Angeles County Department of Health Services, Santa Fe Springs, CA, USA.
Abstract
BACKGROUND: Motor vehicle intrusion (MVI) is one of the field triage criteria recommended by the American College of Surgeons Committee of Trauma (ACS-COT) and Centers for Disease Control and Prevention (CDC). However, the evidence supporting its validity is scarce. The purpose of this study was to evaluate the validity of this criterion and assess its impact on overtriage or undertriage. PATIENTS AND METHODS: This was a retrospective study based on the Los Angeles County Trauma and Emergency Medicine Information System (TEMIS) Trauma database. Included in the analysis were patients with MVI as the sole criterion for trauma center triage. Physiological characteristics, severity of injury, and outcomes of the MVI patients were compared between different age groups. Further, a logistic regression model was used to identify factors significantly associated with the need for trauma center resources. RESULTS: During the period 2002-2012, a total of 10,554 trauma patients involved in motor vehicle crashes had documentation of MVI. A subgroup of 3998 patients (37.9%) did not meet any other criteria that require immediate transportation to a designated trauma center. Only 0.7% of these patients had hypotension and 0.1% had deterioration of the Glasgow Coma Scale on admission to the emergency room. Overall, 18.8% of patients required trauma center resources defined as intubation in the emergency room, certain surgical procedures, in-hospital death, or intensive care unit admission. Age ≥65 years, male gender, prehospital heart rate >100/min, and systolic blood pressure <110 mmHg were significantly associated with the need for trauma center resources. CONCLUSIONS: The MVI itself did not appear to be a strong indicator for the use of trauma center resources and is associated with excessive overtriage. However, age >65 years, systolic blood pressure <110 mmHg, and heart rate >100/min were significant predictors for the need of trauma center resources. The MVI criterion should be refined for better utilization of trauma center resources.
BACKGROUND: Motor vehicle intrusion (MVI) is one of the field triage criteria recommended by the American College of Surgeons Committee of Trauma (ACS-COT) and Centers for Disease Control and Prevention (CDC). However, the evidence supporting its validity is scarce. The purpose of this study was to evaluate the validity of this criterion and assess its impact on overtriage or undertriage. PATIENTS AND METHODS: This was a retrospective study based on the Los Angeles County Trauma and Emergency Medicine Information System (TEMIS) Trauma database. Included in the analysis were patients with MVI as the sole criterion for trauma center triage. Physiological characteristics, severity of injury, and outcomes of the MVI patients were compared between different age groups. Further, a logistic regression model was used to identify factors significantly associated with the need for trauma center resources. RESULTS: During the period 2002-2012, a total of 10,554 traumapatients involved in motor vehicle crashes had documentation of MVI. A subgroup of 3998 patients (37.9%) did not meet any other criteria that require immediate transportation to a designated trauma center. Only 0.7% of these patients had hypotension and 0.1% had deterioration of the Glasgow Coma Scale on admission to the emergency room. Overall, 18.8% of patients required trauma center resources defined as intubation in the emergency room, certain surgical procedures, in-hospital death, or intensive care unit admission. Age ≥65 years, male gender, prehospital heart rate >100/min, and systolic blood pressure <110 mmHg were significantly associated with the need for trauma center resources. CONCLUSIONS: The MVI itself did not appear to be a strong indicator for the use of trauma center resources and is associated with excessive overtriage. However, age >65 years, systolic blood pressure <110 mmHg, and heart rate >100/min were significant predictors for the need of trauma center resources. The MVI criterion should be refined for better utilization of trauma center resources.
Authors: Christian Waydhas; Markus Baake; Lars Becker; Boris Buck; Helena Düsing; Björn Heindl; Kai Oliver Jensen; Rolf Lefering; Carsten Mand; T Paffrath; Uwe Schweigkofler; Kai Sprengel; Heiko Trentzsch; Bernd Wohlrath; Dan Bieler Journal: World J Surg Date: 2018-09 Impact factor: 3.352
Authors: Nicholas Manguso; Galinos Barmparas; Navpreet K Dhillon; Eric J Ley; Raymond Huang; Nicolas Melo; Rodrigo F Alban; Daniel R Margulies Journal: Surg Open Sci Date: 2019-10-22
Authors: D Bieler; H Trentzsch; M Baacke; L Becker; H Düsing; B Heindl; K O Jensen; R Lefering; C Mand; O Özkurtul; T Paffrath; U Schweigkofler; K Sprengel; B Wohlrath; C Waydhas Journal: Unfallchirurg Date: 2018-10 Impact factor: 1.000
Authors: Joshua R Lupton; Cynthia Davis-O'Reilly; Rebecca M Jungbauer; Craig D Newgard; Mary E Fallat; Joshua B Brown; N Clay Mann; Gregory J Jurkovich; Eileen Bulger; Mark L Gestring; E Brooke Lerner; Roger Chou; Annette M Totten Journal: Acad Emerg Med Date: 2022-04-22 Impact factor: 5.221