BACKGROUND: The American College of Surgeons' Committee on Trauma (ACSCOT) has developed field triage guidelines intended to identify seriously injured patients. Unlike the 1990 version, the 1993 revision calls for on-line medical control assistance with the triage decision for patients whose only marker of severe injury is the mechanism of their injury. We prospectively examined the application of the 1990 ACSCOT field triage guidelines to evaluate Emergency Medical Service (EMS) utilization of these guidelines and the potential effects of the 1993 revision. STUDY DESIGN: Emergency Medical Service personnel identified all ACSCOT criteria applicable to patients delivered to the level 1 trauma center at the Medical University of South Carolina. Trauma registry data were used to compare actual injury severity with applicable indicators. Patients with an injury severity score greater than or equal to 16 were considered seriously injured. The South Carolina state trauma and EMS databases were queried to estimate systemwide overtriage and undertriage rates. RESULTS: Questionnaires were completed for 753 patients over 19 months of study. One hundred twenty-two patients had serious injuries. The estimated systemwide overtriage and undertriage rates were 2.7 and 20.3 percent, respectively. Physiologic criteria had a 64.8 percent sensitivity and a 41.8 percent positive predictive value (PPV). The addition of anatomic criteria increased sensitivity to 82.8 percent and decreased PPV to 26.9 percent. Adding mechanism of injury increased sensitivity to 95.1 percent but further reduced PPV to 18.2 percent. Review of EMS records suggests that the addition of on-line medical control for patients in whom only the mechanism of injury triage guidelines apply could improve PPV with little effect on sensitivity. CONCLUSIONS: The current ACSCOT field triage guidelines are appropriate when applied by field EMS personnel.
BACKGROUND: The American College of Surgeons' Committee on Trauma (ACSCOT) has developed field triage guidelines intended to identify seriously injured patients. Unlike the 1990 version, the 1993 revision calls for on-line medical control assistance with the triage decision for patients whose only marker of severe injury is the mechanism of their injury. We prospectively examined the application of the 1990 ACSCOT field triage guidelines to evaluate Emergency Medical Service (EMS) utilization of these guidelines and the potential effects of the 1993 revision. STUDY DESIGN: Emergency Medical Service personnel identified all ACSCOT criteria applicable to patients delivered to the level 1 trauma center at the Medical University of South Carolina. Trauma registry data were used to compare actual injury severity with applicable indicators. Patients with an injury severity score greater than or equal to 16 were considered seriously injured. The South Carolina state trauma and EMS databases were queried to estimate systemwide overtriage and undertriage rates. RESULTS: Questionnaires were completed for 753 patients over 19 months of study. One hundred twenty-two patients had serious injuries. The estimated systemwide overtriage and undertriage rates were 2.7 and 20.3 percent, respectively. Physiologic criteria had a 64.8 percent sensitivity and a 41.8 percent positive predictive value (PPV). The addition of anatomic criteria increased sensitivity to 82.8 percent and decreased PPV to 26.9 percent. Adding mechanism of injury increased sensitivity to 95.1 percent but further reduced PPV to 18.2 percent. Review of EMS records suggests that the addition of on-line medical control for patients in whom only the mechanism of injury triage guidelines apply could improve PPV with little effect on sensitivity. CONCLUSIONS: The current ACSCOT field triage guidelines are appropriate when applied by field EMS personnel.
Authors: Craig D Newgard; Dana Zive; James F Holmes; Eileen M Bulger; Kristan Staudenmayer; Michael Liao; Thomas Rea; Renee Y Hsia; N Ewen Wang; Ross Fleischman; Jonathan Jui; N Clay Mann; Jason S Haukoos; Karl A Sporer; K Dean Gubler; Jerris R Hedges Journal: J Am Coll Surg Date: 2011-12 Impact factor: 6.113
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: Craig D Newgard; Maria J Nelson; Michael Kampp; Somnath Saha; Dana Zive; Terri Schmidt; Mohamud Daya; Jonathan Jui; Lynn Wittwer; Craig Warden; Ritu Sahni; Mark Stevens; Kyle Gorman; Karl Koenig; Dean Gubler; Pontine Rosteck; Jan Lee; Jerris R Hedges Journal: J Trauma Date: 2011-06
Authors: Craig D Newgard; Renee Y Hsia; N Clay Mann; Terri Schmidt; Ritu Sahni; Eileen M Bulger; N Ewen Wang; James F Holmes; Ross Fleischman; Dana Zive; Kristan Staudenmayer; Jason S Haukoos; Nathan Kuppermann Journal: J Trauma Acute Care Surg Date: 2013-05 Impact factor: 3.313
Authors: Craig D Newgard; Rongwei Fu; Dana Zive; Tom Rea; Susan Malveau; Mohamud Daya; Jonathan Jui; Denise E Griffiths; Lynn Wittwer; Ritu Sahni; K Dean Gubler; Jonathan Chin; Pat Klotz; Stephanie Somerville; Tina Beeler; T J Bishop; Tara N Garland; Eileen Bulger Journal: J Am Coll Surg Date: 2015-11-14 Impact factor: 6.113
Authors: Craig D Newgard; Robert H Schmicker; Jerris R Hedges; John P Trickett; Daniel P Davis; Eileen M Bulger; Tom P Aufderheide; Joseph P Minei; J Steven Hata; K Dean Gubler; Todd B Brown; Jean-Denis Yelle; Berit Bardarson; Graham Nichol Journal: Ann Emerg Med Date: 2009-09-23 Impact factor: 5.721