Improving the Field Triage of Major Trauma Victims

Abstract

The Trauma Scores, CRAMS scales, and mechanisms of injury of 500 trauma patients were evaluated for their ability to identify a seriously injured patient. Serious injury was defined as one of the following: Injury Severity Score (ISS) > 15, or emergency-room Trauma Score .ltoreq. 14, or injuries requiring > 3 days hospitalization, or death. With the addition of specific mechanisms of injury (auto vs. pedestrian accident at > 5 m.p.h., motor vehicle accident at > 40 m.p.h., motorcycle accident at > 20 m.p.h., or a major assault), the sensitivity of a field Trauma Score of < 14 could be improved from 45% to 75%, with a reasonable specificity of 40%. With these same mechanisms, the sensitivity of a CRAMS scale of .ltoreq. 8 increased from 66% to 93%, with a specificity of 30%. The addition of these mechanisms of injury to standard field triage scoring appears to improve the identification of seriously injured patients while retaining an acceptable level of overtriage.