We have located links that may give you full text access.
Association of Prehospital Step 1 Vital Sign Criteria and Vital Sign Decline with Increased Emergency Department and Hospital Death.
Journal of the American College of Surgeons 2020 December 19
INTRODUCTION: This study analyzed data from the 2017 American College of Surgeons National Trauma Data Bank to examine the effects of pre-hospital Field Triage Decision Scheme Step 1 vital sign criteria (S1C) and vital sign decline on subsequent Emergency Department (ED) and hospital death in Emergency Medical Services (EMS) transported trauma victims.
METHODS: Patient and injury characteristics, transport time, and ED and hospital disposition were collected. S1C (RR<10, RR>29, SBP<90, GCS<14) were recorded at the injury scene and hospital arrival. Decline was defined as a change of ≥1SD into or within an S1C range. S1C and decline were analyzed relative to ED and hospital death using logistic regression.
RESULTS: Of 333,213 included patients, 54,849 (16.5%) met Step 1 criteria at the scene and 21,566 (6.9%) declined en route. The ED death rate was 0.4% (n=1,188), and the hospital death/hospice rate was 4.0% (11,624/287,675). Patients who met S1C at the scene or who declined were more likely to require longer hospital lengths of stay, ICU admission, and surgical intervention. S1C and decline patients had higher odds of death in both the ED (S1C odds ratio [OR] 15.1, decline OR 2.4, p's <.001) and hospital (S1C OR=4.8, decline OR 2.0, p's <.001) after adjusting for patient demographics, transport time and mode, injury severity, and injury mechanism. Each S1C and decline measure was independently predictive of death.
CONCLUSIONS: This study quantifies the mortality risks associated with individual S1C and validates their use as an indicator for injury severity and pre-hospital triage tool.
METHODS: Patient and injury characteristics, transport time, and ED and hospital disposition were collected. S1C (RR<10, RR>29, SBP<90, GCS<14) were recorded at the injury scene and hospital arrival. Decline was defined as a change of ≥1SD into or within an S1C range. S1C and decline were analyzed relative to ED and hospital death using logistic regression.
RESULTS: Of 333,213 included patients, 54,849 (16.5%) met Step 1 criteria at the scene and 21,566 (6.9%) declined en route. The ED death rate was 0.4% (n=1,188), and the hospital death/hospice rate was 4.0% (11,624/287,675). Patients who met S1C at the scene or who declined were more likely to require longer hospital lengths of stay, ICU admission, and surgical intervention. S1C and decline patients had higher odds of death in both the ED (S1C odds ratio [OR] 15.1, decline OR 2.4, p's <.001) and hospital (S1C OR=4.8, decline OR 2.0, p's <.001) after adjusting for patient demographics, transport time and mode, injury severity, and injury mechanism. Each S1C and decline measure was independently predictive of death.
CONCLUSIONS: This study quantifies the mortality risks associated with individual S1C and validates their use as an indicator for injury severity and pre-hospital triage tool.
Full text links
Related Resources
Trending Papers
Challenges in Septic Shock: From New Hemodynamics to Blood Purification Therapies.Journal of Personalized Medicine 2024 Februrary 4
Molecular Targets of Novel Therapeutics for Diabetic Kidney Disease: A New Era of Nephroprotection.International Journal of Molecular Sciences 2024 April 4
Perioperative echocardiographic strain analysis: what anesthesiologists should know.Canadian Journal of Anaesthesia 2024 April 11
The 'Ten Commandments' for the 2023 European Society of Cardiology guidelines for the management of endocarditis.European Heart Journal 2024 April 18
Get seemless 1-tap access through your institution/university
For the best experience, use the Read mobile app
All material on this website is protected by copyright, Copyright © 1994-2024 by WebMD LLC.
This website also contains material copyrighted by 3rd parties.
By using this service, you agree to our terms of use and privacy policy.
Your Privacy Choices
You can now claim free CME credits for this literature searchClaim now
Get seemless 1-tap access through your institution/university
For the best experience, use the Read mobile app