Bond et al combined the prehospital index (PHI) and mechanism of injury (MOI) for field triage of trauma patients. The authors are from the University of Calgary.
Parameters:
(1) prehospital index (PHI, described above)
(2) type of trauma
Prehospital Index (without penetrating injury, maximal score 20 points)
|
Parameter |
Finding |
Points |
|
systolic blood pressure |
> 100 mm Hg |
0 |
|
|
86-100 mm Hg |
1 |
|
|
75-85 mm Hg |
2 |
|
|
0-74 mm Hg |
5 |
|
pulse |
51-119 beats per minute |
0 |
|
|
>= 120 beats per minute |
3 |
|
|
<= 50 beats per minute |
5 |
|
respirations |
normal |
0 |
|
|
shallow and/or labored |
3 |
|
|
< 10 per minutes, or intubated |
5 |
|
consciousness |
normal |
0 |
|
|
confused and/or combative |
3 |
|
|
no intelligible words |
5 |
where:
• It would be interesting to see if the use of penetrating trauma would improve performance.
|
Parameter |
Finding |
Points |
|
prehospital index |
0 to 3 |
0 |
|
|
>= 4 |
1 |
|
type of trauma |
motor vehicle crash with death or serious injury to another occupant of the same car |
1 |
|
|
motor vehicle crash with steering wheel deformity |
1 |
|
|
motor vehicle crash with structural intrusion into the passenger compartment > 20 inches |
1 |
|
|
fall > 15 feet |
1 |
|
|
fall with head involvement |
1 |
|
|
fall down a staircase |
1 |
|
|
motorcycle crash with victim ejected at > 30 km/h (> 18.6 miles/h) |
1 |
|
|
pedestrian struck at a velocity > 15 km/h (> 9.3 miles/h) |
1 |
|
|
none of the above |
0 |
combined score =
= SUM(points for all of the features present)
Interpretation:
• minimum score: 0
• maximum score: 3 or more
• A combined score >= 1 indicates major trauma (ISS >= 16).
Performance:
• The sensitivity of the PHI alone was 41% with specificity of 98%.
• The sensitivity of the mechanism of injury alone was 73% with specificity of 91%.
• The sensitivity of the combined score was 78% with specificity of 89%. The negative predictive value is 99%. Overtriage was reduced.
Limitation:
• The combined score did not identify all major trauma patients.
Specialty: Surgery, orthopedic, Emergency Medicine, Critical Care, Surgery, general
