The Journal of Trauma: Injury, Infection, and Critical Care · 1991 · 121 citations · 0 references
MedicineEmergency Medical ServicesEmergency MedicineEmergencyPrehospital Emergency CareResuscitationEmergency TriagePrehospital Trauma CareTrauma AssessmentTrauma ResuscitationTrauma TriageTriage SystemsEms Performance MeasurementPrehospital Trauma AssessmentPrehospital Trauma TriageRevised Trauma ScoreTrauma Scoring SystemsTrauma Severity ScoringTriageTriage Scoring Systems
Trauma triage instruments have been developed, but few studies have shown they outperform emergency medical technician (EMT) judgment in deciding transport to a trauma center. This study compares EMT judgment with the triage‑revised Trauma Score, Prehospital Index, and CRAMS scale. Data from Cleveland EMS patients were collected, with EMTs rating overall severity on a 4‑point scale and estimating mortality probability. EMT mortality predictions were as accurate as the three scoring systems, and in a subset of patients EMT assessment matched the scores in identifying those who died or required emergent operative intervention, indicating EMT judgment is equally effective at detecting high‑risk patients.
A number of instruments have been devised to aid in the triage of trauma patients. Little work, however, has been done to demonstrate that these triage instruments offer an advantage over the judgment of an emergency medical technician (EMT) in determining which patients require transportation to a trauma center. The purpose of this study was to compare EMT judgment against three scoring systems; the triage-revised Trauma Score, the Prehospital Index, and the CRAMS scale. Data were gathered on trauma victims transported by the City of Cleveland EMS system. The EMTs rated the patient's overall severity on a 4-point scale and estimated the probability of patient mortality. We found that the EMT prediction of mortality was as accurate as the various scores. In a subset of patients, we also found that the EMT assessment performed as well as the scoring systems in identifying patients who either died or required emergent operative intervention. We conclude that EMT judgment is as accurate as these three scoring systems in identifying patients at high risk for death or the need for immediate operative intervention.