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Crash Telemetry-Based Injury Severity Prediction is Equivalent to or Out-Performs Field Protocols in Triage of Planar Vehicle Collisions

Part of: Technology Developments in Prehospital and Disaster Medicine

Published online by Cambridge University Press:  19 July 2019

Katherine He Open the ORCID record for Katherine He [Opens in a new window] ,
Peng Zhang  and
Stewart C. Wang
Katherine He*
Affiliation:
Department of Surgery, Brigham and Women’s Hospital, Boston, Massachusetts, USA Department of Surgery, University of Michigan, Ann Arbor, Michigan, USA
Peng Zhang
Affiliation:
Department of Surgery, Division of Acute Care Surgery, University of Michigan, Ann Arbor, Michigan, USA
Stewart C. Wang
Affiliation:
Department of Surgery, Division of Acute Care Surgery, University of Michigan, Ann Arbor, Michigan, USA
*
Correspondence: Katherine He, MD, MS Surgery Education Office Brigham and Women’s Hospital 75 Francis Street – CA034 Boston, Massachusetts 02115 USA E-mail: [email protected]
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Abstract

Introduction:

With the increasing availability of vehicle telemetry technology, there is great potential for Advanced Automatic Collision Notification (AACN) systems to improve trauma outcomes by detecting patients at-risk for severe injury and facilitating early transport to trauma centers.

Methods:

National Automotive Sampling System Crashworthiness Data System (NASS-CDS) data from 1999-2013 were used to construct a logistic regression model (injury severity prediction [ISP] model) predicting the probability that one or more occupants in planar, non-rollover motor vehicle collisions (MVCs) would have Injury Severity Score (ISS) 15+ injuries. Variables included principal direction of force (PDOF), change in velocity (Delta-V), multiple impacts, presence of any older occupant (≥55 years old), presence of any female occupant, presence of right-sided passenger, belt use, and vehicle type. The model was validated using medical records and 2008-2011 crash data from AACN-enabled Michigan (USA) vehicles identified from OnStar (OnStar Corporation; General Motors; Detroit, Michigan USA) records. To compare the ISP to previously established protocols, a literature search was performed to determine the sensitivity and specificity of first responder identification of ISS 15+ for MVC occupants.

Results:

The study population included 924 occupants in 836 crash events. The ISP model had a sensitivity of 72.7% (95% Confidence Interval [CI] 41%-91%) and specificity of 93% (95% CI 92%-95%) for identifying ISS 15+ occupants injured in planar MVCs. The current standard 2006 Field Triage Decision Scheme (FTDS) was 56%-66% sensitive and 75%-88% specific in identifying ISS 15+ patients.

Conclusions:

The ISP algorithm comparably is more sensitive and more specific than current field triage in identifying MVC patients at-risk for ISS 15+ injuries. This real-world field study shows telemetry data transmitted before dispatch of emergency medical systems can be helpful to quickly identify patients who require urgent transfer to trauma centers.

Keywords

Emergency Medical Servicesfield triageinjury severitytrauma centervehicle telemetry
Type
Original Research
Information
Prehospital and Disaster Medicine , Volume 34 , Issue 4 , August 2019 , pp. 356 - 362
Copyright
© World Association for Disaster and Emergency Medicine 2019 

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References

Sasser, S, Hunt, R, Sullivent, E, Wald, M. Guidelines for field triage of injured patients’ recommendations of the national expert panel on field triage, 2009. MMWR Recomm Rep. 2009;58(RR01):1–35.Google Scholar
MacKenzie, EJ, Rivara, FP, Jurkovich, GJ, et al. A national evaluation of the effect of trauma-center care on mortality. N Engl J Med. 2006;354(4):366–378.CrossRefGoogle ScholarPubMed
Cudnik, MT, Newgard, CD, Sayre, MR, Steinberg, SM. Level I versus Level II trauma centers: an outcomes-based assessment. J Trauma Inj Infect Crit Care. 2009;66(5):1321–1326.CrossRefGoogle ScholarPubMed
Baxt, WG, Jones, G, Fortlage, D. The trauma triage rule: a new, resource-based approach to the prehospital identification of major trauma victims. Ann Emerg Med. 1990;19(12):1401–1406.CrossRefGoogle ScholarPubMed
Sasser, SM, Hunt, RC, Faul, M, et al. Guidelines for field triage of injured patients: recommendations of the national expert panel on field triage, 2011. MMWR Recomm Rep. 2012;61(RR-1):1–20.Google Scholar
Hamada, SR, Gauss, T, Duchateau, F-X, et al. Evaluation of the performance of French physician-staffed emergency medical service in the triage of major trauma patients. J Trauma Acute Care Surg. 2014;76(6):1476–1483.CrossRefGoogle ScholarPubMed
Newgard, CD, Uribe-Leitz, T, Haider, AH. Under-triage remains a vexing problem for even the most highly developed trauma systems. JAMA Surg. 2018;153(4):328.CrossRefGoogle Scholar
Staudenmayer, KL, Hsia, RY, Mann, NC, Spain, DA, Newgard, CD. Triage of elderly trauma patients: a population-based perspective. J Am Coll Surg. 2013;217(4):569–576.CrossRefGoogle ScholarPubMed
Kodadek, LM, Selvarajah, S, Velopulos, CG, Haut, ER, Haider, AH Under-triage of older trauma patients: is this a national phenomenon? J Surg Res. 2015;199(1):220–229.CrossRefGoogle Scholar
Newgard, CD, Fu, R, Lerner, EB, et al. Deaths and high-risk trauma patients missed by standard trauma data sources. J Trauma Acute Care Surg. 2017;83(3):427–437.CrossRefGoogle ScholarPubMed
FARS Encyclopedia. https://www-fars.nhtsa.dot.gov/Main/index.aspx. Accessed January 10, 2018.Google Scholar
CDC. Non-Fatal Data. WISQARS Injury Center. https://www.cdc.gov/injury/wisqars/nonfatal.html. Accessed January 10, 2018.Google Scholar
National Center for Injury Prevention and Control. Recommendations from the Expert Panel: Advanced Automatic Collision Notification and Triage of the Injured Patient. Atlanta, Georgia USA: Centers for Disease Control and Prevention; 2008. https://stacks.cdc.gov/view/cdc/5304/. Accessed January 10, 2018.Google Scholar
Hunt, RC. Emerging communication technologies in emergency medical services. Prehosp Emerg Care. 2002;6(1):131–136.CrossRefGoogle ScholarPubMed
Kononen, DW, Flannagan, CAC, Wang, SC. Identification and validation of a logistic regression model for predicting serious injuries associated with motor vehicle crashes. Accid Anal Prev. 2011;43(1):112–122.CrossRefGoogle ScholarPubMed
OnStar Services. https://www.onstar.com/us/en/services/services.html. Accessed November 22, 2017.Google Scholar
van Rein, EAJ, Houwert, RM, Gunning, AC, Lichtveld, RA, Leenen, LPH, van Heijl, M. Accuracy of prehospital triage protocols in selecting severely injured patients: a systematic review. J Trauma Acute Care Surg. 2017;83(2):328–339.CrossRefGoogle ScholarPubMed
Gray, A, Goyder, EC, Goodacre, SW, Johnson, GS. Trauma triage: a comparison of CRAMS and TRTS in a UK population. Injury. 1997;28(2):97–101.CrossRefGoogle Scholar
Lerner, EB, Shah, MN, Swor, RA, et al. Comparison of the 1999 and 2006 trauma triage guidelines: where do patients go? Prehosp Emerg Care. 2011;15(1):12–17.CrossRefGoogle ScholarPubMed
Newgard, CD, Zive, D, Holmes, JF, et al. A multisite assessment of the American College of Surgeons Committee on Trauma Field Triage Decision Scheme for identifying seriously injured children and adults. J Am Coll Surg. 2011;213(6):709–721.CrossRefGoogle ScholarPubMed
Bond, RJ, Kortbeek, JB, Preshaw, RM. Field trauma triage: combining mechanism of injury with the prehospital index for an improved trauma triage tool. J Trauma. 1997;43(2):283–287.CrossRefGoogle ScholarPubMed
Champion, HR, Sacco, WJ, Copes, WS, Gann, DS, Gennarelli, TA, Flanagan, ME. A revision of the Trauma Score. J Trauma. 1989;29(5):623–629.CrossRefGoogle ScholarPubMed
Knopp, R, Yanagi, A, Kallsen, G, Geide, A, Doehring, L. Mechanism of injury and anatomic injury as criteria for prehospital trauma triage. Ann Emerg Med. 1988;17(9):895–902.CrossRefGoogle ScholarPubMed
Newgard, CD, Hsia, RY, Mann, NC, et al. The trade-offs in field trauma triage. J Trauma Acute Care Surg. 2013;74(5):1298–1306.Google ScholarPubMed
Tamim, H, Joseph, L, Mulder, D, Battista, RN, Lavoie, A, Sampalis, JS. Field triage of trauma patients: improving on the Prehospital Index. Am J Emerg Med. 2002;20(3):170–176.CrossRefGoogle ScholarPubMed
Hamada, S, Gauss, T, Duchateau, F, et al. Evaluation of the performance of French physician-staffed emergency medical service in the triage of major trauma patients. J Trauma Acute Care Surg. 2014;76(6):1476–1483.CrossRefGoogle ScholarPubMed
Newgard, CD, Yang, Z, Nishijima, D, et al. Cost-effectiveness of field trauma triage among injured adults served by Emergency Medical Services. J Am Coll Surg. 2016;222(6):1125–1137.CrossRefGoogle ScholarPubMed
Newgard, CD, Staudenmayer, K, Hsia, RY, et al. The cost of over-triage: more than one-third of low-risk injured patients were taken to major trauma centers. Health Aff (Millwood). 2013;32(9):1591–1599.CrossRefGoogle Scholar
NHTSA Center for Statistics and Analysis. Rural/Urban Comparison of Traffic Fatalities. https://crashstats.nhtsa.dot.gov/#/PublicationList/56. Accessed November 27, 2017.Google Scholar
Barnett, AS, Wang, NE, Sahni, R, et al. Variation in prehospital use and uptake of the National Field Triage Decision Scheme. Prehosp Emerg Care. 2013;17(2):135–148.CrossRefGoogle ScholarPubMed
Sasser, SM, Ossmann, E, Wald, MM, Lerner, EB, Hunt, RC. Adoption of the 2006 field triage decision scheme for injured patients. West J Emerg Med. 2011;12(3):275–283.Google ScholarPubMed
Nakamura, Y, Daya, M, Bulger, EM, et al. Evaluating age in the field triage of injured persons. Ann Emerg Med. 2012;60(3):335–345.CrossRefGoogle ScholarPubMed
Garwe, T, Stewart, K, Stoner, J, et al. Out-of-hospital and inter-hospital under-triage to designated tertiary trauma centers among injured older adults: a 10-year statewide geospatial-adjusted analysis. Prehosp Emerg Care. 2017;21(6):734–743.CrossRefGoogle ScholarPubMed
Morris, JA, MacKenzie, EJ, Damiano, AM, Bass, SM. Mortality in trauma patients: the interaction between host factors and severity. J Trauma. 1990;30(12):1476–1482.CrossRefGoogle ScholarPubMed
Shifflette, VK, Lorenzo, M, Mangram, AJ, Truitt, MS, Amos, JD, Dunn, EL. Should age be a factor to change from a Level II to a Level I trauma activation? J Trauma. 2010;69(1):88–92.CrossRefGoogle ScholarPubMed
Newgard, CD, Holmes, JF, Haukoos, JS, et al. Improving early identification of the high-risk elderly trauma patient by emergency medical services. Injury. 2016;47(1):19–25.CrossRefGoogle ScholarPubMed
Newgard, CD, Richardson, D, Holmes, JF, et al. Physiologic field triage criteria for identifying seriously injured older adults. Prehosp Emerg Care. 2014;18(4):461–470.CrossRefGoogle ScholarPubMed
Willenbring, BD, Lerner, EB, Brasel, K, et al. Evaluation of a consensus-based criterion standard definition of trauma center need for use in field triage research. Prehosp Emerg Care. 2016;20(1):1–5.CrossRefGoogle ScholarPubMed
Newgard, CD, Hedges, JR, Diggs, B, Mullins, RJ. Establishing the need for trauma center care: anatomic injury or resource use? Prehosp Emerg Care. 2008;12(4):451–458.CrossRefGoogle ScholarPubMed