Introduction. Trauma triage protocols are important because they identify, at the injury scene, patients with major injuries requiring transfer to a Level I trauma center, from those with non-major injuries who could be treated at Levels II and III trauma centers. The Pre-hospital Index (PHI) is a physiological injury severity measure which may be used as a trauma triage tool. / Purpose. The purpose of the present study was to: (1) prospectively evaluate the predictive ability of the PHI in identifying trauma patients with major versus non-major injuries, and (2) develop a trauma triage scale which incorporates, along with the PHI, a subset of the variables age, body region injured, mechanism of injury, comorbidity, and time between 911 call and departure of the ambulance from the injury site, so as to improve the predictive ability of the PHI-based triage instrument. / Methods. This study was based on 1,291 trauma patients treated in Montreal between April 1993 and December 1996. A patient was considered to have major injuries if the patient died within seven days since hospital admission, had an intensive care unit admission within seven days, or major surgery performed within four days. Three hypothetical trauma triage protocols were developed using logistic regression analysis; where the model that describes the data best was selected according to Bayes factor approximation. In detecting major versus non-major injuries, sensitivities, specificities, positive and negative predictive values were calculated for all the cutoff points of the PHI and the triage protocols. Also, areas under the Receiver Operating Characteristic (ROC) curves were calculated and compared for these instruments. / Results. The trauma triage protocol which included the variables age, body region injured, mechanism of injury, comorbidity, and PHI produced the best combination of sensitivity and specificity; of 0.95, and 0.24, respectively. This algorithm underwent a significant improvement over the PHI (area under the ROC curve: 0.76 versus 0.66, p < 0.05). / Conclusion. An improvement in the predictive ability of the PHI-based triage instrument was introduced after the addition of the variables age, body region injured, mechanism of injury, and co-morbidity.
| Identifer | oai:union.ndltd.org:LACETR/oai:collectionscanada.gc.ca:QMM.35633 |
| Date | January 1997 |
| Creators | Tamim, Hala. |
| Contributors | Samfalis, John (advisor) |
| Publisher | McGill University |
| Source Sets | Library and Archives Canada ETDs Repository / Centre d'archives des thèses électroniques de Bibliothèque et Archives Canada |
| Language | English |
| Detected Language | English |
| Type | Electronic Thesis or Dissertation |
| Format | application/pdf |
| Coverage | Doctor of Philosophy (Department of Epidemiology and Biostatistics.) |
| Rights | All items in eScholarship@McGill are protected by copyright with all rights reserved unless otherwise indicated. |
| Relation | alephsysno: 001605490, proquestno: NQ44606, Theses scanned by UMI/ProQuest. |
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