Prehospital prediction of the severity of blunt anatomic injury
Prehospital prediction of the severity of blunt anatomic injury
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DOI：
10.1097/01.ta.0000244384.85267.c5
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发表时间：
2008-03-01
影响因子：
--
通讯作者：
Bernard, Stephen A.
中科院分区：
文献类型：
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作者：
Mulholland, Stephen A.;Cameron, Peter A.;Bernard, Stephen A.
目的：评估护理人员预测需要重大创伤服务的患者的能力。为了评估是否护理人员预测的严重程度，个别身体区域的损伤是准确的，可以添加到整体的护理人员预测的损伤severity.Methods：直升机护理人员在维多利亚前瞻性地记录了头部，胸部和腹部区域的损伤的严重程度，以及患者是否需要一个重大的创伤服务，为主要反应成人（>15岁）创伤患者。将护理人员对损伤的预测与患者结局进行比较。严重创伤被定义为在医院死亡;损伤严重程度评分>15;重症监护室入院>24小时;和紧急手术。严重解剖损伤定义为简明损伤量表严重度>= 3。敏感性，特异性，阳性预测值和阴性预测值进行了计算。结果：207例患者参加了这项研究，与62.3%定义为重大创伤。护理人员预测的灵敏度范围为头部57.6（95%置信区间[CI]; 45.4-68.9）至腹部38.5（95% CI; 22.1-57.9）。特异性范围从胸部的98.3（95% CI; 93.5-99.6）至头部区域的93.5（95% CI; 87.9-96.6）。护理人员预测严重创伤状态的敏感性和特异性分别为97.7（95%CI; 93-99.2）和28.2（95%CI; 19.3-39.1）。护理人员正确分类所有患者谁被送进重症监护室，需要紧急手术或在医院死亡的重大traumatic.Conclusions：护理人员无法可靠地识别严重的损伤，个别身体部位。护理人员判断严重创伤状态的敏感性高。对身体各个部位损伤严重程度的评估似乎并不能提高准确性。
Objectives: To evaluate the ability of paramedics to predict patients requiring a major trauma service. To assess whether paramedic prediction of severity of injury to individual body regions is accurate and could add to overall paramedic prediction of injury severity.Methods: Helicopter paramedics in Victoria prospectively recorded the severity of injury to the head, thoracic, and abdomen regions, and whether the patient required a major trauma service, for primary response adult (>15 years) trauma patients. Paramedic predictions of injuries were compared with patient outcomes. Major trauma was defined as death in hospital; an Injury Severity Score >15; intensive care unit admission >24 hours; and urgent surgery. A severe anatomic injury was defined as an Abbreviated Injury Scale severity >= 3. The sensitivity, specificity, positive predictive value, and negative predictive value were calculated.Results: Two hundred and seven patients were enrolled in the study, with 62.3% defined as major trauma. The sensitivity of paramedic predictions ranged from 57.6 (95% confidence interval [CI]; 45.4-68.9) for the head to 38.5 (95% CI; 22.1-57.9) for the abdomen. Specificities ranged from 98.3 (95% CI; 93.5-99.6) for the thorax to 93.5 (95 % CI; 87.9-96.6) for the head region. The sensitivity and specificity of paramedic predictions of a major trauma status were 97.7 (95% CI; 93-99.2) and 28.2 (95% CI; 19.3-39.1), respectively. The paramedics correctly categorized all patients who were admitted to an intensive care unit, required urgent surgery or died in hospital as major trauma.Conclusions: Paramedics were unable to reliably identify severe injury to individual body regions. Sensitivity of paramedic judgment of major trauma status was high. Assessment of the severity of injury to individual body regions did not appear to improve accuracy.