Mechanism of injury and special considerations as predictive of serious injury: A systematic review

Abstract

Objectives: The Centers for Disease Control and Prevention's field triage guidelines (FTG) are routinely used by emergency medical services personnel for triaging injured patients. The most recent (2011) FTG contains physiologic, anatomic, mechanism, and special consideration steps. Our objective was to systematically review the criteria in the mechanism and special consideration steps that might be predictive of serious injury or need for a trauma center.

Methods: We conducted a systematic review of the predictive utility of mechanism and special consideration criteria for predicting serious injury. A research librarian searched in Ovid Medline, EMBASE, and the Cochrane databases for studies published between January 2011 and February 2021. Eligible studies were identified using a priori inclusion and exclusion criteria. Studies were excluded if they lacked an outcome for serious injury, such as measures of resource use, injury severity scores, mortality, or composite measures using a combination of outcomes. Given the heterogeneity in populations, measures, and outcomes, results were synthesized qualitatively focusing on positive likelihood ratios (LR+) whenever these could be calculated from presented data or adjusted odds ratios (aOR).

Results: We reviewed 2418 abstracts and 315 full-text publications and identified 42 relevant studies. The factors most predictive of serious injury across multiple studies were death in the same vehicle (LR+ 2.2-7.4), ejection (aOR 3.2-266.2), extrication (LR+ 1.1-6.6), lack of seat belt use (aOR 4.4-11.3), high speeds (aOR 2.0-2.9), concerning crash variables identified by vehicle telemetry systems (LR+ 4.7-22.2), falls from height (LR+ 2.4-5.9), and axial load or diving (aOR 2.5-17.6). Minor or inconsistent predictors of serious injury were vehicle intrusion (LR+ 0.8-7.2), cardiopulmonary or neurologic comorbidities (LR+ 0.8-3.1), older age (LR+ 0.6-6.8), or anticoagulant use (LR+ 1.1-1.8).

Conclusions: Select mechanism and special consideration criteria contribute positively to appropriate field triage of potentially injured patients.

Keywords: age; emergency medical services; field triage; field triage guidelines; mechanism of injury; prehospital care; serious injury; special considerations; trauma.

FIGURE 1

PRISMA literature flow. Excluded studies (examples) included those that had ineligible populations (nonhuman, nontrauma, cadaver studies, manikins), ineligible interventions (only physiologic or anatomic steps), ineligible comparison (descriptive study of all patients with a given factor), ineligible outcome (no outcome for serious injury), ineligible setting (in hospital), ineligible study design (case reports), or ineligible publication type (editorials) or were non‐English studies, not conducted in the United States, reviews. or publications without primary data

FIGURE 2

Graphical representation of the LR+ for serious injury and mortality by age cutoff. Included studies were those reporting the positive LR for serious injury or mortality by patient age, , , , ,