Prehospital prediction of the severity of blunt anatomic injury

Abstract

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.