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Awarded Grant - Acute Care

Evaluation of the Mechanism of Injury Components of the Trauma Triage Criteria

FOA Number: CE06-005: Research Grants for the Care of the Acutely Injured
Project Period: 9/1/2006 – 8/31/2009
Application/Grant Number: 1-R49-CE001010-01
Principal Investigator: Lerner, E. Brooke
University of Rochester
601 Elmwood Ave.
Box 655
Rochester, NY 14642
Email: e.lerner@rochester.edu

Description

Transporting patients with severe trauma to trauma centers can reduce their risk of death. Emergency Medical Service (EMS) providers must appropriately identify which patients will benefit from the special resources of a trauma center. This requires them to have evidence based trauma triage tools. This study examines the most commonly used tool, the American College of Surgeon's Field Triage Criteria. Specifically, we will evaluate the mechanism of injury component of the Criteria to determine which of the listed conditions are predictive of trauma center need. The specific aims are: (1) to determine which patients with traumatic injuries, who meet any of the conditions under the mechanism of injury component of the Criteria need a trauma center; (2) to identify thresholds for the measurable conditions under the mechanism of injury component that are the best predictors of trauma center need; and, (3) to determine the accuracy of field provider estimates of the measurable conditions at motor vehicle crashes (MVC). This will be accomplished by gathering data at three trauma centers. Data will be gathered on all patients transported by EMS for an injury related to an MVC, motorcycle crash, fall, pedestrian or bicycle struck. This will include patients of all severity levels. Patient enrollers will interview EMS to determine which of the criteria the patient met. The patient will then be followed to determine their outcome. Two measures will be used as a proxy for trauma center need: Injury Severity Score greater than 15; and, (2) a composite measure of admission to the intensive care unit, emergent non-orthopedic surgery, and death. The sensitivity and specificity of the current conditions under the mechanism of injury component of the criteria will be calculated. In addition, for the measurable conditions Receiver Operator Curves will be generated to determine the ideal cut point. Finally, professional crash investigators will be sent to a sub-set of MVC to determine if EMS estimates are accurate. The public will benefit from this research because we will have validated the individual conditions under the mechanism of injury component of the Field Triage Criteria. This information will advance clinical practice by providing the scientific evidence needed to modify the current Field Triage Criteria. This modification would minimize under and over triage of injured patients so as to decrease morbidity and mortality and allow both the EMS and trauma system to be more efficient for the treatment of all patients.

 
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