Joshua B Brown1, Mark L Gestring, Francis X Guyette, Matthew R Rosengart, Nicole A Stassen, Raquel M Forsythe, Timothy R Billiar, Andrew B Peitzman, Jason L Sperry. 1. From the Division of General Surgery and Trauma, Department of Surgery (J.B.B., M.R.R., R.M.F., T.R.B., A.B.P., J.L.S.), University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania; Division of Acute Care Surgery, Department of Surgery (M.L.G., N.A.S.), University of Rochester Medical Center, Rochester, New York; and Department of Emergency Medicine (F.X.G.), University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania.
Abstract
BACKGROUND: The Air Medical Prehospital Triage (AMPT) score was developed to identify injured patients who may benefit from scene helicopter emergency medical services (HEMS) transport. External validation using a different data set is essential to ensure reliable performance. The study objective was to validate the effectiveness of the AMPT score to identify patients with a survival benefit from HEMS using the Pennsylvania Trauma Outcomes Study registry. METHODS: Patients 16 years or older undergoing scene HEMS or ground EMS (GEMS) transport in the Pennsylvania Trauma Outcomes Study registry 2000-2013 were included. Patients with 2 or higher AMPT score points were triaged to HEMS, while those with less than 2 points were triaged to GEMS. Multilevel Poisson regression determined the association of survival with actual transport mode across AMPT score triage assignments, adjusting for demographics, mechanism, vital signs, interventions, and injury severity. Successful validation was defined as no survival benefit for actual HEMS transport in patients triaged to GEMS by the AMPT score, with a survival benefit for actual HEMS transport in patients triaged to HEMS by the AMPT score. Subgroup analyses were performed in patients treated by advanced life support providers and patients with transport times longer than 10 minutes. RESULTS: There were 222,827 patients included. For patients triaged to GEMS by the AMPT score, actual transport mode was not associated with survival (adjusted relative risk, 1.004; 95% confidence interval, 0.999-1.009; p = 0.08). For patients triaged to HEMS by the AMPT score, actual HEMS transport was associated with a 6.7% increase in the relative probability of survival (adjusted relative risk, 1.067; 95% confidence interval, 1.040-1.083, p < 0.001). Similar results were seen in all subgroups. CONCLUSIONS: This study is the first to externally validate the AMPT score, demonstrating the ability of this tool to reliably identify trauma patients most likely to benefit from HEMS transport. The AMPT score should be considered when protocols for HEMS scene transport are developed and reviewed. LEVEL OF EVIDENCE: Epidemiologic/prognostic study, level III; therapeutic/care management study, level IV.
BACKGROUND: The Air Medical Prehospital Triage (AMPT) score was developed to identify injured patients who may benefit from scene helicopter emergency medical services (HEMS) transport. External validation using a different data set is essential to ensure reliable performance. The study objective was to validate the effectiveness of the AMPT score to identify patients with a survival benefit from HEMS using the Pennsylvania Trauma Outcomes Study registry. METHODS:Patients 16 years or older undergoing scene HEMS or ground EMS (GEMS) transport in the Pennsylvania Trauma Outcomes Study registry 2000-2013 were included. Patients with 2 or higher AMPT score points were triaged to HEMS, while those with less than 2 points were triaged to GEMS. Multilevel Poisson regression determined the association of survival with actual transport mode across AMPT score triage assignments, adjusting for demographics, mechanism, vital signs, interventions, and injury severity. Successful validation was defined as no survival benefit for actual HEMS transport in patients triaged to GEMS by the AMPT score, with a survival benefit for actual HEMS transport in patients triaged to HEMS by the AMPT score. Subgroup analyses were performed in patients treated by advanced life support providers and patients with transport times longer than 10 minutes. RESULTS: There were 222,827 patients included. For patients triaged to GEMS by the AMPT score, actual transport mode was not associated with survival (adjusted relative risk, 1.004; 95% confidence interval, 0.999-1.009; p = 0.08). For patients triaged to HEMS by the AMPT score, actual HEMS transport was associated with a 6.7% increase in the relative probability of survival (adjusted relative risk, 1.067; 95% confidence interval, 1.040-1.083, p < 0.001). Similar results were seen in all subgroups. CONCLUSIONS: This study is the first to externally validate the AMPT score, demonstrating the ability of this tool to reliably identify traumapatients most likely to benefit from HEMS transport. The AMPT score should be considered when protocols for HEMS scene transport are developed and reviewed. LEVEL OF EVIDENCE: Epidemiologic/prognostic study, level III; therapeutic/care management study, level IV.
Authors: Akkie N Ringburg; Gijs de Ronde; Stephen H Thomas; Esther M M van Lieshout; Peter Patka; Inger B Schipper Journal: Prehosp Emerg Care Date: 2009 Jan-Mar Impact factor: 3.077
Authors: Joshua B Brown; Jason L Sperry; Anisleidy Fombona; Timothy R Billiar; Andrew B Peitzman; Francis X Guyette Journal: J Am Coll Surg Date: 2015-01-24 Impact factor: 6.113
Authors: Adil H Haider; Taimur Saleem; Jeffrey J Leow; Cassandra V Villegas; Mehreen Kisat; Eric B Schneider; Elliott R Haut; Kent A Stevens; Edward E Cornwell; Ellen J MacKenzie; David T Efron Journal: J Am Coll Surg Date: 2012-02-07 Impact factor: 6.113
Authors: Joshua B Brown; Matthew R Rosengart; Raquel M Forsythe; Benjamin R Reynolds; Mark L Gestring; William M Hallinan; Andrew B Peitzman; Timothy R Billiar; Jason L Sperry Journal: J Trauma Acute Care Surg Date: 2016-07 Impact factor: 3.313
Authors: Joshua B. Brown; Kenneth J. Smith; Mark L. Gestring; Matthew R. Rosengart; Timothy R. Billiar; Andrew B. Peitzman; Jason L. Sperry; Joel S. Weissman Journal: JAMA Surg Date: 2018-03-01 Impact factor: 14.766
Authors: Andrew-Paul Deeb; Heather M Phelos; Andrew B Peitzman; Timothy R Billiar; Jason L Sperry; Joshua B Brown Journal: J Trauma Acute Care Surg Date: 2021-07-01 Impact factor: 3.697