Newgard et al reviewed physiologic field triage criteria for an older trauma victim. They revised cutoffs for physiologic findings that may indicate more serious injury. The authors are from multiple institutions from around the United States.
Patient: older trauma patient (>= 55 years of age)
Serious injury was an ISS >= 16.
Parameters:
(1) Glasgow coma scale (GCS)
(2) respiratory rate in breaths per minute
(3) systolic blood pressure in mm Hg
Parameter
Finding
Points
Glasgow coma scale
15
0
3 to 14
1
respiratory rate
< 10
1
10 to 24
0
> 24
1
systolic blood pressure
< 110
1
110 to 200
0
> 200
1
score =
= SUM(points for all 3 parameters)
Interpretation:
• minimum score: 0
• maximum score: 3
• A patient with a score >= 1 should be transported to a trauma center.
Performance:
• The sensitivity went from 79 to 86% but specificity went from 76 to 61%.
• Use of the score will increase the rate of overtriage but reduce the risk of missing a serious injury (undertriage).
A shock index (heart rate divided by systolic blood pressure) > 1.0 is also associated with more significant trauma.
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