Open AccessJournal Article
Guidelines for field triage of injured patients recommendations of the national expert panel on field triage.
Scott M. Sasser,Scott M. Sasser,Richard C. Hunt,Ernest E. Sullivent,Marlena M. Wald,Jane Mitchko,Gregory J. Jurkovich,Mark C. Henry,Jeffrey P. Salomone,Stewart C. Wang,Robert L. Galli,Arthur Cooper,Lawrence H. Brown,Richard W. Sattin +13 more
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In this paper, the authors present the dissemination and impact of the 2006 Guidelines for field triage of injured patients; outlines the methodology used by the Panel for its 2011 review; explains the revisions and modifications to the physiologic, anatomic, mechanism-of-injury, and special considerations criteria; and provides the rationale used by Panel for these changes.Abstract:
In the United States, injury is the leading cause of death for persons aged 1-44 years. In 2008, approximately 30 million injuries were serious enough to require the injured person to visit a hospital emergency department (ED); 5.4 million (18%) of these injured patients were transported by Emergency Medical Services (EMS). On arrival at the scene of an injury, the EMS provider must determine the severity of injury, initiate management of the patient's injuries, and decide the most appropriate destination hospital for the individual patient. These destination decisions are made through a process known as "field triage," which involves an assessment not only of the physiology and anatomy of injury but also of the mechanism of the injury and special patient and system considerations. Since 1986, the American College of Surgeons Committee on Trauma (ACS-COT) has provided guidance for the field triage process through its "Field Triage Decision Scheme." This guidance was updated with each version of the decision scheme (published in 1986, 1990, 1993, and 1999). In 2005, CDC, with financial support from the National Highway Traffic Safety Administration, collaborated with ACS-COT to convene the initial meetings of the National Expert Panel on Field Triage (the Panel) to revise the decision scheme; the revised version was published in 2006 by ACS-COT (American College of Surgeons. Resources for the optimal care of the injured patient: 2006. Chicago, IL: American College of Surgeons; 2006). In 2009, CDC published a detailed description of the scientific rationale for revising the field triage criteria (CDC. Guidelines for field triage of injured patients: recommendations of the National Expert Panel on Field Triage. MMWR 2009;58[No. RR-1]). In 2011, CDC reconvened the Panel to review the 2006 Guidelines in the context of recently published literature, assess the experiences of states and local communities working to implement the Guidelines, and recommend any needed changes or modifications to the Guidelines. This report describes the dissemination and impact of the 2006 Guidelines; outlines the methodology used by the Panel for its 2011 review; explains the revisions and modifications to the physiologic, anatomic, mechanism-of-injury, and special considerations criteria; updates the schematic of the 2006 Guidelines; and provides the rationale used by the Panel for these changes. This report is intended to help prehospital-care providers in their daily duties recognize individual injured patients who are most likely to benefit from specialized trauma center resources and is not intended as a mass casualty or disaster triage tool. The Panel anticipates a review of these Guidelines approximately every 5 years.read more
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Circulating mitochondrial DAMPs cause inflammatory responses to injury
Qin Zhang,Mustafa Raoof,Yu Chen,Yuka Sumi,Tolga Sursal,Wolfgang G. Junger,Karim Brohi,Kiyoshi Itagaki,Carl J. Hauser +8 more
TL;DR: It is shown that injury releases mitochondrial DAMPs into the circulation with functionally important immune consequences, including formyl peptides and mitochondrial DNA, which promote PMN Ca2+ flux and phosphorylation of mitogen-activated protein (MAP) kinases, thus leading to PMN migration and degranulation in vitro and in vivo.
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TL;DR: The burden of TBI as regards age group, gender, costs, race, emergency department visits, hospitalizations, and deaths, and injury trends over a 15 year period are examined.
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Trends in Traumatic Brain Injury in the U.S. and the public health response: 1995-2009.
Victor G. Coronado,Lisa C. McGuire,Kelly Sarmiento,Jeneita M. Bell,Michael R. Lionbarger,Christopher D. Jones,Andrew I. Geller,Nayla M. Khoury,Likang Xu +8 more
TL;DR: To reduce of the burden and mitigate the impact of TBI in the United States, an improved state- and territory-specific TBI surveillance system that accurately measures burden and includes information on the acute and long-term outcomes is needed.
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Results of the CONTROL trial: efficacy and safety of recombinant activated Factor VII in the management of refractory traumatic hemorrhage.
Carl J. Hauser,Kenneth D. Boffard,Richard P. Dutton,Gordon R. Bernard,Martin A. Croce,John B. Holcomb,Ari Leppäniemi,Michael Parr,Jean Louis Vincent,Bartholomew J. Tortella,Jeannett Dimsits,Bertil Bouillon +11 more
TL;DR: Recombinant Factor VIIa reduced blood product use but did not affect mortality compared with placebo, paradoxically making outcomes studies increasingly difficult.
Journal ArticleDOI
Guidelines for Field Triage of Injured Patients: In conjunction with the Morbidity and Mortality Weekly Report published by the Center for Disease Control and Prevention.
TL;DR: The methodology, findings and updated guidelines from the Morbidity & Mortality Weekly Report (MMWR) from the 2011 Panel are presented along with commentary on the burden of injury in the U.S., and the role emergency physicians have in impacting morbidity and mortality at the population level.
References
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Journal ArticleDOI
ASSESSMENT OF COMA AND IMPAIRED CONSCIOUSNESS: A Practical Scale
Graham M. Teasdale,Bryan Jennett +1 more
TL;DR: A clinical scale has been evolved for assessing the depth and duration of impaired consciousness and coma that facilitates consultations between general and special units in cases of recent brain damage, and is useful also in defining the duration of prolonged coma.
Journal ArticleDOI
The injury severity score: a method for describing patients with multiple injuries and evaluating emergency care
TL;DR: Results of this investigation indicate that the Injury Severity Score represents an important step in solving the problem of summarizing injury severity, especially in patients with multiple trauma.
Journal ArticleDOI
A National Evaluation of the Effect of Trauma-Center Care on Mortality
Ellen J. MacKenzie,Frederick P. Rivara,Gregory J. Jurkovich,Avery B. Nathens,Katherine Frey,Brian L. Egleston,David S. Salkever,Daniel O. Scharfstein +7 more
TL;DR: It is shown that the risk of death is significantly lower when care is provided in a trauma center than in a non-trauma center and argue for continued efforts at regionalization.
Journal ArticleDOI
A revision of the Trauma Score.
Howard R. Champion,William J. Sacco,Wayne S. Copes,Donald S. Gann,Thomas A. Gennarelli,Maureen E. Flanagan +5 more
TL;DR: T-RTS, the sum of coded values of GCS, SBP, and RR, demonstrated increased sensitivity and some loss in specificity when compared with a triage criterion based on TS and GCS values, and RTS demonstrated substantially improved reliability in outcome predictions compared to the TS.
Journal ArticleDOI
The Major Trauma Outcome Study: establishing national norms for trauma care.
Howard R. Champion,Wayne S. Copes,William J. Sacco,Mary M. Lawnick,Susan L. Keast,Lawrence W. Bain,Maureen E. Flanagan,Charles F. Frey +7 more
TL;DR: The Major Trauma Outcome Study (MTOS) is a retrospective descriptive study of injury severity and outcome coordinated through the American College of Surgeons' Committee on Trauma from 1982 through 1987.