Evaluation of Trauma Triage Criteria Performance in a Regional Trauma System

Mechanism of injury and special considerations as predictive of serious injury: A systematic review

“…34 Three studies excluded those meeting Step 1 and 2 criteria and evaluated composite outcomes indicative of trauma center need. These found that low-speed collisions (<20 mph) were less predictive of serious injury than high-speed (>20 mph) collisions in adults (LR+ 0.4 and 1.5, respectively) 15 and children varied by patient age. [15][16][17]25,33,[35][36][37][38] In studies in an older age population (≥70 years-old), head injuries were more common from falls regardless of height, whereas in pediatrics, falls over 10 ft were associated with higher odds for serious injury.…”

“…These found that low-speed collisions (<20 mph) were less predictive of serious injury than high-speed (>20 mph) collisions in adults (LR+ 0.4 and 1.5, respectively) 15 and children varied by patient age. [15][16][17]25,33,[35][36][37][38] In studies in an older age population (≥70 years-old), head injuries were more common from falls regardless of height, whereas in pediatrics, falls over 10 ft were associated with higher odds for serious injury. For studies of adults of any age, falls over 15 ft were less predictive of trauma center need (LR+ 2.4) 15 than falls over 20 ft (LR+ 5.2) 16 when evaluating only patients not meeting Step 1 or 2 FTG criteria.…”

“…[15][16][17] Five studies with low to moderate risk of bias examined ejection of an individual after an MVC, one evaluating ISS ≥ 16 but not excluding those meeting physiologic or anatomic criteria finding a LR+ of 1.0 18 ; two evaluating composite outcomes of trauma center need in those not meeting physiologic or anatomic criteria, reporting LR+ of 3.0 15 and 3.2 16 ; and two evaluated aOR (95% CI) for mortality (10.5 reporting a LR+ of 1.1 for ISS ≥ 16 18 when not excluding those meeting physiologic or anatomic FTG criteria and three excluding those meeting physiologic or anatomic criteria, finding higher LR+ for composite outcomes indicative of trauma center need (range 2.2-6.6). [15][16][17] Two studies with moderate risk of bias found that the odds of mortality 22,23 when seat belts were not used and lower odds of severe injury when seat belts were used. 21 Four studies with low to moderate risk of bias evaluated vehicle intrusion including roof crush using LRs with mixed results (LR+ 0.64-7.2).…”

“…This broad range may be due to one study including orthopedic surgery at any time (LR+ 7.2) 24 in their composite outcome whereas the other studies excluded orthopedic surgeries (LR+ 0.64-3.7). 15,16,18 Vehicle rollover was assessed in two studies of low and moderate risk of bias reporting LR+ for composite outcome indicative of trauma center need (0.8-1.0). 16,17 One study, with a high risk of bias and not included with the aggregate results above, reported an aOR (95% CI) for a composite Motorcycle and moped MVC characteristics were evaluated in two studies with moderate risk of bias, with one reporting lower likelihood of mortality when wearing a helmet (LR+ 0.50), 26 whereas the other noted a speed over 20 mph or rider separation from the vehicle was not predictive of composite outcomes for trauma center need (LR+ 1.1 and 1.0, respectively).…”

“…[15][16][17]25,33,[35][36][37][38] In studies in an older age population (≥70 years-old), head injuries were more common from falls regardless of height, whereas in pediatrics, falls over 10 ft were associated with higher odds for serious injury. For studies of adults of any age, falls over 15 ft were less predictive of trauma center need (LR+ 2.4) 15 than falls over 20 ft (LR+ 5.2) 16 when evaluating only patients not meeting Step 1 or 2 FTG criteria. In one study with high risk of bias, mechanisms in children younger than 14 were assessed, with higher likelihood of mortality from firearm injury (LR+ 2.4) or assault of any kind (LR+ 4.1) regardless of the anatomic location of the injury.…”