Volume 23 Supplement 1
Pre-hospital data as risk predictors of seriousness among traumatically injured patients
© Franzén et al. 2015
Published: 16 July 2015
Currently many hospitals activate a trauma team with a predefined large team of health care professionals as a response to a trauma call. For hospitals with limited resources, this is a demanding process, which weakens the overall hospital performance by allocating considerable resources to the trauma room. Most trauma calls are based on trauma schemes scores from a combination of physiologic- anatomic injury- and injury mechanism criteria. In the search for indicators which might be used for a more differentiated hospital response, the aim of this study was to investigate the relative importance of pre-hospital variables in identifying "high risk" patients.
The study was a historical prospective cohort study conducted at a level 2 trauma hospital in Southern Denmark. The inclusion criterion was traumatically injured patients above 14 years of age, requiring activation of the trauma team over a one-year period. The outcome was "high risk" patients, requiring one or more of the following: In-hospital stay more than 48 hours, orthopaedic or non-orthopaedic surgery performed, ICU stay, transfer to another hospital, or injury related death within 30 days. Logistic regression was used to evaluate the relationship between pre-hospital variables and high risk.
Of the 393 injured patients included, 30.0% were high risk patients. Statistically significant independent variables associated with high risk included anatomic injury criteria (OR = 5.5; 95% CI: 2.13-14.23), age 35-55 years (OR = 2.7; 95% CI: 1.31-5.55), age above 55 years (OR = 4.8; 95% CI: 2.30-9.97), pre-hospital systolic blood pressure 90-110 mmHg (OR = 3.8; 95% CI 1.02-13.92), "pedestrian struck by motor vehicle" (OR = 4.3; 95% CI: 1.42-12.76), and oxygen saturation 90-94% (OR = 3.4; 95% CI: 1.30-8.64).
Our findings demonstrate that age, systolic blood pressure, oxygen saturation, and anatomic injury criteria are associated with high risk traumas and should be considered for inclusion in a trauma team activation protocol and further tested in such a model. Besides pedestrians struck by motor vehicle, the mechanism of injury has revealed poor predictive capabilities.
This article is published under license to BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.