ArticleScandinavian journal of trauma, resuscitation and emergency medicine2010
Paramedics' and pre-hospital physicians' assessments of anatomic injury in trauma patients: a cohort study.
Article in Scandinavian journal of trauma, resuscitation and emergency medicine, 2010. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 4 papers.
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Who cites it
4 citing papers in PubMed.
- Cutoff of the reverse shock index multiplied by the Glasgow coma scale for predicting in-hospital mortality in adult patients with trauma: a retrospective cohort study.BMC emergency medicine · 2024Article
- Diagnostic accuracy of clinical examination to identify life- and limb-threatening injuries in trauma patients.Scandinavian journal of trauma, resuscitation and emergency medicine · 2023Article
- Factors Affecting Treatment with Life-Saving Interventions, Computed Tomography Scans and Specialist Consultations.International journal of environmental research and public health · 2020Article
- Micropower impulse radar: a novel technology for rapid, real-time detection of pneumothorax.Emergency medicine international · 2011Article
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5 authors.
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Abstract
backgroundThe pre-hospital assessment of a blunt trauma is difficult. Common triage tools are the mechanism of injury (MOI), vital signs, and anatomic injury (AI). Compared to the other tools, the clinical assessment of anatomic injury is more subjective than the others, and, hence, more dependent on the skills of the personnel.The aim of the study was to estimate whether the training and qualifications of the personnel are associated with the accuracy of prediction of anatomic injury and the completion of pre-hospital procedures indicated by local guidelines.
methodsAdult trauma patients met by a trauma team at Helsinki University Trauma Centre during a 12-month period (n = 422) were retrospectively analysed. To evaluate the accuracy of prediction of anatomic injury, clinically assessed pre-hospital injuries in six body regions were compared to injuries assessed at hospital in two patient groups, the patients treated by pre-hospital physicians (group 1, n = 230) and those treated by paramedics (group 2, n = 190).
resultsThe groups were comparable in respect to age, sex, and MOI, but the patients treated by physicians were more severely injured than those treated by paramedics [ISS median (interquartile range) 16 (6-26) vs. 6 (2-10)], thus rendering direct comparison of the groups ineligible. The positive predictive values (95% confidence interval) of assessed injury were highest in head injury [0,91 (0,84-0,95) in group 1 and 0,86 (0,77-0,92) in group 2]. The negative predictive values were highest in abdominal injury [0,85 (0,79-0,89) in group 1 and 0,90 (0,84-0,93) in group 2]. The measurements of agreement between injuries assessed pre- and in-hospitally were moderate in thoracic and extremity injuries. Substantial kappa values (95% confidence interval) were achieved in head injury, 0,67 (0,57-0,77) in group 1 and 0,63 (0,52-0,74) in group 2. The rate of performing the pre-hospital procedures as indicated by the local instructions was 95-99%, except for decompression of tension pneumothorax.
conclusionAccurate prediction of anatomic injury is challenging. No conclusive differences were seen in the ability of pre-hospital physicians and paramedics to predict anatomic injury in the respective patient populations.
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