A multicenter validation of the prehospital index

EMS Provider Determinations of Necessity for Transport and Reimbursement for EMS Response, Medical Care, and Transport: Combined Resource Document for the National Association of EMS Physicians Position Statements

“…Ambulance transport for such patients, however, is clearly appropriate and the question is not whether they require ED evaluation, but rather to which ED they should be taken. A number of criteria and scoring systems are available to support trauma triage decisions, [71][72][73][74][75][76] although some studies have shown independent paramedic judgment of trauma severity to have comparable levels of sensitivity and specificity. 73,77,78 Determinations about medical necessity for air medical transport are a similar issue.…”

Long-Term Evaluation of Prehospital Trauma Patient Triage in a Large Urban Area*

“…It has been our experience that in trauma patients who fall outside the protocols, the tendency is for overtriage of these patients to level I centers and this problem contributes to overcrowding in these centers. The PHI has been shown to accurately predict the need for emergency life-saving surgery within 4 h and mortality within 72 h [15,17].…”

“…This index was validated in several multicenter studies [15][16][17][18][19]. The PHI comprises four components: systolic blood pressure, heart rate, respiratory status, and level of consciousness.…”

The association between vital signs and major hemorrhagic injury is significantly improved after controlling for sources of measurement variability

“…Alternatively, failure to describe key methodology that improved vital sign accuracy (eg, superior equipment, training, or study protocols) would make it harder for others to replicate a successful study. Consider that some reports support the usefulness of prehospital severity scores for trauma patients [12][13][14], whereas other studies found those scores ineffective [15,16]. In these examples, the reports lacked any explicit consideration of the measurement apparatus, clinical protocols, and quality assurance processes related to vital sign measurements; and inconsistency in how vital signs were measured could have contributed to the heterogeneous findings.…”