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003 IS MECHANISM OF INJURY ALONE A USEFUL PREDICTOR IN PREHOSPITAL TRAUMA TRIAGE
M. Boyle1, F. Archer, E. Smith.1Monash University
Introduction: The Review of Trauma and Emergency Services in Victoria 1999 left unresolved the predictive value of mechanism of injury in prehospital trauma triage guidelines. International literature is controversial, with previous studies focusing on major trauma defined at hospital and neglecting the prehospital perspective where these important triage decisions are made. The objective was to determine if mechanism of injury is a useful predictor in prehospital trauma triage.
Methods: All Victorian ambulance trauma patient care records (PCRs) for 2002 were reviewed. PCRs where patients were physiological stable, had no significant pattern of injury, but had a significant mechanism of injury were identified and compared to the State Trauma Registry to determine those patients who sustained retrospectively defined major trauma. Data were stored in a Microsoft Access database, cleaned, and loaded into statistical software for analysis. Ethics committee approval was obtained.
Results: There were 53 360 trauma incidents. Of these, 7.7% were mechanism of injury only, of which 62% were males and 38% females, median age was 28 years. The majority of patients with mechanism of injury were involved in a MCA>60 km/hr (n = 1822): of these only nine (0.5%) sustained retrospectively defined major trauma. The other main mechanisms were motor cyclist/cyclist (n = 1459), of whom 0.2% sustained major trauma; patients in a vehicular rollover (n = 524) of whom none sustained major trauma; and a fall from greater than 5 m (n = 38), of whom 5.2% sustained major trauma. This study is potentially limited by the retrospective nature of the data collection.
Conclusions: The study suggests that individual mechanism of injury criteria have no clinical or operational significance in prehospital trauma triage of patients who have an absence of physiological distress and no significant pattern of injury. These results add to the knowledge base …
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