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Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine

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Open Access 01-12-2010 | Original research

Paramedics' and pre-hospital physicians' assessments of anatomic injury in trauma patients: a cohort study

Authors: Hetti Kirves, Lauri Handolin, Mika Niemelä, Janne Pitkäniemi, Tarja Randell

Published in: Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine | Issue 1/2010

Abstract

Background

The 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.

Methods

Adult 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).

Results

The 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.

Conclusion

Accurate 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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Title: Paramedics' and pre-hospital physicians' assessments of anatomic injury in trauma patients: a cohort study
Authors: Hetti Kirves
Lauri Handolin
Mika Niemelä
Janne Pitkäniemi
Tarja Randell
Publication date: 01-12-2010
Publisher: BioMed Central
Published in: Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine / Issue 1/2010
Electronic ISSN: 1757-7241
DOI: https://doi.org/10.1186/1757-7241-18-60

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Paramedics' and pre-hospital physicians' assessments of anatomic injury in trauma patients: a cohort study

Abstract

Background

Methods

Results

Conclusion

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Background

Methods

Results

Conclusion

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