Noninvasive Continuous Physiologic Data Acquisition and Analysis as a Predictor of Outcome Following Major Trauma: A Pilot Study

Abstract : The ability to accurately triage trauma patients can be problematic in the prehospital environment. Many prehospital triage scores have been developed to facilitate this process, perhaps demonstrating that a good deal of uncertainty remains in these methods. 1-18 The primary reason to perform prehospital scoring is to determine if the patient should be transported immediately to a trauma center (TC) and thus benefit from the TC's ability to rapidly provide lifesaving interventions (LSI), resulting in the survival of patients that would have otherwise died. 19-27 The potential benefit of the TC is related to the concentration of experienced personnel and technology at one location that specializes in the care of seriously injured patients. Organized TC's have been shown to decrease preventable mortality in the intermediate group of patients that arrive seriously ill. Mortality in current mature TC's is approximately 3% of admissions and usually occurs in patients that have devastating injuries and a very low probability of survival, despite very aggressive diagnostic and intervention maneuvers.27 Thus using mortality as the primary endpoint of a prehospital triage tool only identifies those small numbers of patients who received a LSI and died at the TC rather than those who received LSI and benefited from the intervention. Others have recommended utilizing an Injury Severity score (ISS) > 15 as an indicator of appropriate triage, however these data are not available until hospital discharge. This highlights the fact that while ISS is often appropriately used to retrospectively compare outcome between groups of patients, the data that are used to compile the ISS are not available until discharge from the hospital. Thus the ISS is not a tool that can be utilized for prehospital or even ED triage. More importantly, up to 25% of patients with low (1 - 9)ISS scores required the resources available at TC's.28.