2020
DOI: 10.1007/s00068-020-01410-4
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ISS alone, is not sufficient to correctly assign patients post hoc to trauma team requirement

Abstract: Purpose An injury severity score (ISS) ≥ 16 alone, is commonly used post hoc to define the correct activation of a trauma team. However, abnormal vital functions and the requirement of life-saving procedures may also have a role in defining trauma team requirement post hoc. The aim of this study was to describe their prevalence and mortality in severely injured patients and to estimate their potential additional value in the definition of trauma team requirement as compared to the definition based on ISS alone… Show more

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Cited by 15 publications
(8 citation statements)
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“…The fact that 31 deceased patients did not fulfil any consensus-based risk criteria should not be considered to be a fault of the criteria. Whether these deceased patients (Table 4) would have been detected by the two non-verifiable criteria is highly unlikely as injuries requiring pericardiocentesis or a tourniquet generally coincide with a much higher ISS and severe disturbance of vital functions [25]. In view of the advanced age of most of these patients, it is possible that an advance health care directive, a living will or patient wish communicated by family members prevented further treatment.…”
Section: Discussionmentioning
confidence: 99%
“…The fact that 31 deceased patients did not fulfil any consensus-based risk criteria should not be considered to be a fault of the criteria. Whether these deceased patients (Table 4) would have been detected by the two non-verifiable criteria is highly unlikely as injuries requiring pericardiocentesis or a tourniquet generally coincide with a much higher ISS and severe disturbance of vital functions [25]. In view of the advanced age of most of these patients, it is possible that an advance health care directive, a living will or patient wish communicated by family members prevented further treatment.…”
Section: Discussionmentioning
confidence: 99%
“…Overtriage is extensive [ 18 , 19 , 20 ] and consumes finite resources in cases of mass casualties and could therefore contribute to a negative overall survival rate [ 10 ].…”
Section: Discussionmentioning
confidence: 99%
“…However, not every patient with ISS 16+ might need the full trauma team, while several patients with an ISS below 16 might benefit from a TTA [ 10 ]. Therefore, in recent years, other criteria, which are sometimes subsumed under the term “need for trauma intervention”, have gained wider acceptance [ 7 , 11 , 12 , 13 , 14 , 15 , 16 , 17 , 18 , 19 ] and have been shown to be superior to the classification based on injury severity alone [ 10 , 13 , 17 , 18 ]. Examples of these criteria include the transfusion of red blood cells, mechanical ventilation, admission to ICU, or need for interventional radiology [ 13 ].…”
Section: Introductionmentioning
confidence: 99%
“…1 While in many ways the ISS is a useful metric to quantify injury severity, for example for research and communication purposes, it is limited in its ability to retrospectively analyze the fidelity of triage decisions, especially given its strictly post-hoc application. 17,18 The ISS is also particularly limited in its ability to quantify severity of penetrating injury, as the system cannot account for the compounded severity of a projectile damaging multiple organs within a single body region. Newer triage accuracy scoring systems such as the Need for Trauma Intervention (NFTI) 19 and the Need for Emergent Intervention within 6 hours (NEI-6) 20 are credited for better reflecting the need for early mobilization of trauma center resources and personnel.…”
Section: Discussionmentioning
confidence: 99%