Objective: To evaluate the accuracy of emergency medical services (EMS) provider judgment for traumatic intracranial hemorrhage (tICH) in older patients following head trauma in the field. We also compared EMS provider judgment with other sets of field triage criteria. Methods: This was a prospective observational cohort study conducted with five EMS agencies and 11 hospitals in Northern California. Patients 55 years and older who experienced blunt head trauma were transported by EMS between August 1, 2015 and September 30, 2016, and received an initial cranial computed tomography (CT) imaging, were eligible. EMS providers were asked, "What is your suspicion for the patient having intracranial hemorrhage (bleeding in the brain)?" Responses were recorded as ordinal categories (<1%, 1-5%, >5-10%, >10-50%, or >50%) and the incidences of tICH were recorded for each category. The accuracy of EMS provider judgment was compared to other sets of triage criteria, including current field triage criteria, current field triage criteria plus multivariate logistical regression risk factors, and actual transport. Results: Among the 673 patients enrolled, 319 (47.0%) were male and the median age was 75 years (interquartile range 64-85). Seventy-six (11.3%) patients had tICH on initial cranial CT imaging. The increase in EMS provider judgment correlated with an increase in the incidence of tICH. EMS provider judgment had a sensitivity of 77.6% (95% CI 67.1-85.5%) and a specificity of 41.5% (37.7-45.5%) when using a threshold of 1% or higher suspicion for tICH. Current field triage criteria (Steps 1-3) was poorly sensitive (26.3%, 95% CI 17.7-37.2%) in identifying tICH and current field trial criteria plus multivariate logistical regression risk factors was sensitive (97.4%, 95% CI 90.9-99.3%) but poorly specific (12.9%, 95% CI 10.4-15.8%). Actual transport was comparable to EMS provider judgment (sensitivity 71.1%, 95% CI 60.0-80.0%; specificity 35.3%, 95% CI 31.6-38.3%). Conclusions: As EMS provider judgment for tICH increased, the incidence for tICH also increased. EMS provider judgment, using a threshold of 1% or higher suspicion for tICH, was more accurate than current field triage criteria, with and without additional risk factors included.
Objective: To evaluate the accuracy of emergency medical services (EMS) provider judgment for traumatic intracranial hemorrhage (tICH) in older patients following head trauma in the field. We also compared EMS provider judgment with other sets of field triage criteria. Methods: This was a prospective observational cohort study conducted with five EMS agencies and 11 hospitals in Northern California. Patients 55 years and older who experienced blunt head trauma were transported by EMS between August 1, 2015 and September 30, 2016, and received an initial cranial computed tomography (CT) imaging, were eligible. EMS providers were asked, "What is your suspicion for the patient having intracranial hemorrhage (bleeding in the brain)?" Responses were recorded as ordinal categories (<1%, 1-5%, >5-10%, >10-50%, or >50%) and the incidences of tICH were recorded for each category. The accuracy of EMS provider judgment was compared to other sets of triage criteria, including current field triage criteria, current field triage criteria plus multivariate logistical regression risk factors, and actual transport. Results: Among the 673 patients enrolled, 319 (47.0%) were male and the median age was 75 years (interquartile range 64-85). Seventy-six (11.3%) patients had tICH on initial cranial CT imaging. The increase in EMS provider judgment correlated with an increase in the incidence of tICH. EMS provider judgment had a sensitivity of 77.6% (95% CI 67.1-85.5%) and a specificity of 41.5% (37.7-45.5%) when using a threshold of 1% or higher suspicion for tICH. Current field triage criteria (Steps 1-3) was poorly sensitive (26.3%, 95% CI 17.7-37.2%) in identifying tICH and current field trial criteria plus multivariate logistical regression risk factors was sensitive (97.4%, 95% CI 90.9-99.3%) but poorly specific (12.9%, 95% CI 10.4-15.8%). Actual transport was comparable to EMS provider judgment (sensitivity 71.1%, 95% CI 60.0-80.0%; specificity 35.3%, 95% CI 31.6-38.3%). Conclusions: As EMS provider judgment for tICH increased, the incidence for tICH also increased. EMS provider judgment, using a threshold of 1% or higher suspicion for tICH, was more accurate than current field triage criteria, with and without additional risk factors included.
Entities:
Keywords:
closed; emergency medical services; head injuries
Authors: Craig D Newgard; Michael Kampp; Maria Nelson; James F Holmes; Dana Zive; Thomas Rea; Eileen M Bulger; Michael Liao; John Sherck; Renee Y Hsia; N Ewen Wang; Ross J Fleischman; Erik D Barton; Mohamud Daya; John Heineman; Nathan Kuppermann Journal: J Trauma Acute Care Surg Date: 2012-05 Impact factor: 3.313
Authors: Saul D Levine; Christopher B Colwell; Peter T Pons; Craig Gravitz; Jason S Haukoos; Kevin E McVaney Journal: J Emerg Med Date: 2006-07 Impact factor: 1.484
Authors: Daniel K Nishijima; Samuel Gaona; Trent Waechter; Ric Maloney; Troy Bair; Adam Blitz; Andrew R Elms; Roel D Farrales; Calvin Howard; James Montoya; Jeneita M Bell; Victor C Coronado; David E Sugerman; Dustin W Ballard; Kevin E Mackey; David R Vinson; James F Holmes Journal: Prehosp Emerg Care Date: 2016-09-16 Impact factor: 3.077
Authors: Lawrence H Brown; Michael W Hubble; David C Cone; Michael G Millin; Brian Schwartz; P Daniel Patterson; Brad Greenberg; Michael E Richards Journal: Prehosp Emerg Care Date: 2009 Oct-Dec Impact factor: 3.077
Authors: Ian Roberts; David Yates; Peter Sandercock; Barbara Farrell; Jonathan Wasserberg; Gabrielle Lomas; Rowland Cottingham; Petr Svoboda; Nigel Brayley; Guy Mazairac; Véronique Laloë; Angeles Muñoz-Sánchez; Miguel Arango; Bennie Hartzenberg; Hussein Khamis; Surakrant Yutthakasemsunt; Edward Komolafe; Fatos Olldashi; Yadram Yadav; Francisco Murillo-Cabezas; Haleema Shakur; Phil Edwards Journal: Lancet Date: 2004 Oct 9-15 Impact factor: 79.321
Authors: Daniel K Nishijima; Steven R Offerman; Dustin W Ballard; David R Vinson; Uli K Chettipally; Adina S Rauchwerger; Mary E Reed; James F Holmes Journal: Acad Emerg Med Date: 2013-02 Impact factor: 3.451
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