دورية أكاديمية
An Assessment of Clinical Accuracy of Vital Sign-based Triage Tools Among U.S. and Coalition Forces.
| العنوان: | An Assessment of Clinical Accuracy of Vital Sign-based Triage Tools Among U.S. and Coalition Forces. |
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| المؤلفون: | Vernon TE; Brooke Army Medical Center, JBSA Fort Sam Houston, TX 78234, USA., April MD; 14th Field Hospital, Fort Stewart, GA 31314, USA.; Uniformed Services University of the Health Sciences, Bethesda, MD 20814, USA., Fisher AD; Department of Surgery, University of New Mexico School of Medicine, Albuquerque, NM 87106, USA., Rizzo JA; Brooke Army Medical Center, JBSA Fort Sam Houston, TX 78234, USA.; Uniformed Services University of the Health Sciences, Bethesda, MD 20814, USA., Long BJ; Brooke Army Medical Center, JBSA Fort Sam Houston, TX 78234, USA.; Uniformed Services University of the Health Sciences, Bethesda, MD 20814, USA., Schauer SG; Brooke Army Medical Center, JBSA Fort Sam Houston, TX 78234, USA.; Uniformed Services University of the Health Sciences, Bethesda, MD 20814, USA.; Department of Anesthesiology, University of Colorado School of Medicine, Aurora, CO 80045, USA.; Department of Emergency Medicine, University of Colorado School of Medicine, Aurora, CO 80045, USA.; Center for Combat and Battlefield (COMBAT) Research, University of Colorado School of Medicine, Aurora, CO 80045, USA. |
| المصدر: | Military medicine [Mil Med] 2024 Jul 03; Vol. 189 (7-8), pp. e1528-e1536. |
| نوع المنشور: | Journal Article |
| اللغة: | English |
| بيانات الدورية: | Publisher: Oxford University Press Country of Publication: England NLM ID: 2984771R Publication Model: Print Cited Medium: Internet ISSN: 1930-613X (Electronic) Linking ISSN: 00264075 NLM ISO Abbreviation: Mil Med Subsets: MEDLINE |
| أسماء مطبوعة: | Publication: 2018- : Oxford : Oxford University Press Original Publication: Washington, D.C. : Association of Military Surgeons, United States, 1955- |
| مواضيع طبية MeSH: | Triage*/methods , Triage*/standards , Triage*/statistics & numerical data , Vital Signs*/physiology , Registries*/statistics & numerical data, Humans ; United States/epidemiology ; Male ; Adult ; Female ; Glasgow Coma Scale/statistics & numerical data ; Glasgow Coma Scale/standards ; Military Personnel/statistics & numerical data ; Retrospective Studies ; Wounds and Injuries/mortality ; Wounds and Injuries/therapy |
| مستخلص: | Introduction: Early appropriate allocation of resources for critically injured combat casualties is essential. This is especially important when inundated with an overwhelming number of casualties where limited resources must be efficiently allocated, such as during mass casualty events. There are multiple scoring systems utilized in the prehospital combat setting, including the shock index (SI), modified shock index (MSI), simple triage and rapid treatment (START), revised trauma score (RTS), new trauma score (NTS), Glasgow Coma Scale + age + pressure (GAP), and the mechanism + GAP (MGAP) score. The optimal score for application to the combat trauma population remains unclear. Materials and Methods: This is a secondary analysis of a previously described dataset from the Department of Defense Trauma Registry from January 1, 2007 through March 17, 2020. We constructed univariable analyses to determine the area under the receiving operator characteristic (AUROC) for the scoring systems of interest. Our primary outcomes were early death (within 24 hours) or early massive transfusion, as defined by ≥3 units. Results: There were 12,268 casualties that met inclusion criteria. There were 168 (1%) who died within the first 24 hours and 2082 (17%) that underwent significant transfusion within the first 24 hours. When assessing the predictive capabilities for death within 24 hours, the AUROCs were 0.72 (SI), 0.69 (MSI), 0.89 (START), 0.90 (RTS), 0.83 (NTS), 0.90 (GAP), and 0.91 (MGAP). The AUROCs for massive transfusion were 0.89 (SI), 0.89 (MSI), 0.82 (START), 0.81 (RTS), 0.83 (NTS), 0.85 (MGAP), and 0.86 (GAP). Conclusions: This study retrospectively applied seven triage tools to a database of 12,268 cases from the Department of Defense Trauma Registry to evaluate their performance in predicting early death or massive transfusion in combat. All scoring systems performed well with an AUROC >0.8 for both outcomes. Although the SI and MSI performed best for predicting massive transfusion (both had an AUROC of 0.89), they ranked last for assessment of mortality within 24 hours, with the other tools performing well. START, RTS, NTS, MGAP and GAP reliably identified early death and need for massive transfusion, with MGAP and GAP performing the best overall. These findings highlight the importance of assessing triage tools to best manage resources and ultimately preserve lives of traumatically wounded warfighters. Further studies are needed to explain the surprising performance discrepancy of the SI and MSI in predicting early death and massive transfusion. (Published by Oxford University Press on behalf of the Association of Military Surgeons of the United States 2024. This work is written by (a) US Government employee(s) and is in the public domain in the US.) |
| تواريخ الأحداث: | Date Created: 20240129 Date Completed: 20240703 Latest Revision: 20240704 |
| رمز التحديث: | 20240704 |
| DOI: | 10.1093/milmed/usad500 |
| PMID: | 38285545 |
| قاعدة البيانات: | MEDLINE |
| تدمد: | 1930-613X |
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| DOI: | 10.1093/milmed/usad500 |