Embed Size (px)
DESCRIPTION
emergency
Citation preview
Trauma scoring system to predict mortality rate in emergency
departementAchmad Yani
Background
• Trauma is a time-sensitive condition. Especially during the first hour of trauma management
• Assessment, Resuscitation and Definitive care are very important.
• Providing definitive care earlier at trauma centers has been shown to decrease mortality
Why
TRAUMA
DEATH
First one Hour• assesment•Resucitation
•Definitive care TRAUMA CENTER
When
Two situations that occur in trauma patient care:
• They can be used in the field, before the patient reaches the hospital, to decide whether to send the patient to a trauma center.
• Clinical decision making when the trauma patient has just arrived at the emergency department ED
ClassificationAnatomic Score: Organ Injury Scale by American Association for the surgery of Trauma Abbreviated Injury Scale(AIS) Injury Severity Scale(ISS) Physiologic Score Revised Trauma Score (RTS Triage RTS (T-RTS) Mechanism, Glasgow Coma Scale, Age, and
ArterialPressure (MGAP) Glasgow Coma Scale, Age, and Systolic Blood Pressure(GAP)
Organ Injury Scale
Abbreviated Injury Scale(AIS)
Injury Severity Scale(ISS)• 6 body regions:
(1)head/neck(2)face(3)chest(4)abdomen / pelvis content (5) (6)extremities
• Maximum AIS for three regions• ISS=AIS1
2+AIS22+AIS3
2
• Maximum ISS 75• Any AIS=6 result in ISS= 75
Injury Severity Score Range 1-75
• If injury is assigned a 6 (unsurvivable), ISS automatically = 75
• Score Reflective of Injury Severity 1 - 9 Minor 10 - 15 Moderate 16 - 24 Moderate/Severe ≥ 25 Severe/Critical
Revised Trauma Score(RTS)
Calculating the RTS
AGE >14 YEARS OR BEST GUESS
REVISED TRAUMASCORE (RTS) +4 +3 +2 +1
RESPIRATORY RATE10-29 >29 6-9 <6
SYSTOLIC B/P>89 76-89 50-75 <50
GCS13-15 9-12 6-8 <6
1 +4 +1 = 6
PEDIATRIC TRAUMA SCORE (PTS)
Developed to reflect differences between adult & child physiology
Diminished emphasis on blood pressure Scores reflect size, airway patency, and
severity & multiplicity of obvious wounds Superiority over RTS is as yet unproven
Calculating the PTS
2 +2 -1+1+1 -1 = 4
Combination of Anatomic Score and Physiologic Score
• Trauma Score-Injury Severity Score(TRISS)• Ps=1/(1+e-b)• b= b0+b1*RTS+b2*ISS+b3*Age Index
Application
Objective description of injuryHelp for decision making for clinicianPrediction of patient outcomeEvaluation the performance of care centerSearch for unexpected death
To Trau m a C en ter
Yes
A ssess A n a tom y & M ech an ism o f in ju ry
N o
G C S < 1 3 orS ys to lic B /P < 9 0 or
R esp ira to ry R a te < 1 0 o r > 2 9
M easu re V ita l S ig n s an d L O C
To Trau m a C en ter
Yes
A ssess A n a tom y & M ech an ism o f in ju ry
N o
G C S < 1 3 orS ys to lic B /P < 9 0 or
R esp ira to ry R a te < 1 0 o r > 2 9
M easu re V ita l S ig n s an d L O C
The Champion Trauma Triage Decision Scheme
The Champion Trauma Triage Decision Scheme
To Trau m a C en ter
Yes
A ssess fo r A g e an d P M H
N o
F a ll > 2 0 ' or C rash S p eed > 2 0 m p h or > 2 0 " D efo rm ity o f V eh ic le?R earw ard D isp lacem en t o f F ron t A xle?
E jec tion ? R o llover? D eath o f O th er O ccu p an t?P ed es trian h it a t > 2 0 m p h ?
P en etra tin g In ju ry to C h es t, A b d om en , H ead , N eck , o r G ro in ?2 o r M ore P roxim a l L on g B on e F rac tu res?
C om b in a tion o f B u rn s an d Trau m a?F la il C h es t?
To Trau m a C en ter
Yes
A ssess fo r A g e an d P M H
N o
F a ll > 2 0 ' or C rash S p eed > 2 0 m p h or > 2 0 " D efo rm ity o f V eh ic le?R earw ard D isp lacem en t o f F ron t A xle?
E jec tion ? R o llover? D eath o f O th er O ccu p an t?P ed es trian h it a t > 2 0 m p h ?
P en etra tin g In ju ry to C h es t, A b d om en , H ead , N eck , o r G ro in ?2 o r M ore P roxim a l L on g B on e F rac tu res?
C om b in a tion o f B u rn s an d Trau m a?F la il C h es t?
"W h en in D o ub t, C o n tac t M ed ica l C o n tro l."
C on s id er Trau m a C en te r
Yes
C on tac t M ed ica l C on tro l fo r A d vice
N o
A g e < 5 o r > 5 5 ?K n ow n C ard iac o r R esp ira to ry D isease?
"W h en in D o ub t, C o n tac t M ed ica l C o n tro l."
C on s id er Trau m a C en te r
Yes
C on tac t M ed ica l C on tro l fo r A d vice
N o
A g e < 5 o r > 5 5 ?K n ow n C ard iac o r R esp ira to ry D isease?
The Champion Trauma Triage Decision Scheme
Three Components of Trauma Triage Assessment
• Physiologic• Anatomic• Kinematic
Determine:•Glasgow Coma Scale•Systolic Blood Pressure•Respiratory Rate
Determine:•Glasgow Coma Scale•Systolic Blood Pressure•Respiratory Rate
Calculate:Revised Trauma Score (RTS)orPediatric Trauma Score (PTS)
Calculate:Revised Trauma Score (RTS)orPediatric Trauma Score (PTS)
Is RTS <11 or PTS <8?
Determine: if any of the following exist:Paralysis;Amputation proximal to wrist or ankle;Penetrating injury to chest, abdomen, head or neck;Two or more proximal long bone fractures;Unstable pelvic fracture;Open or depressed skull fracture;Burn associated with trauma
Determine: if there is associated fatality in same vehicle compartment
Determine: if there is associated fatality in same vehicle compartment
YES
YES
YES
NO
NO
NO
I. OLMC confirms RTS/PTS
II. OLMC considers patient transport to Trauma Center, using following guidelines:
a) If transport time by ground or air to Trauma Center is less than 30 minutes, patient should go to Trauma Center directly;
b) If transport time to Trauma Center is greater than 30 minutes, determine the difference in transport time between the Trauma Center and the most accessible hospital:
1) If difference is less than 10 minutes, consider transport to Trauma Center;
2) If difference is greater than 10 minutes, consider transport to most accessible hospital;
III. If, upon arrival in the ED,
a) Facility is not a Trauma Center, and;
b) Patient continues to satisfy criteria of Assessments One and Two, and;
c) Patient can be stabilized for further transport, then receiving ED clinician should provide only life-saving procedures (avoiding unnecessary diagnostics) prior to transport to Trauma Center unless he/she judges clinical situation to not warrant such transfer.
I. OLMC confirms RTS/PTS
II. OLMC considers patient transport to Trauma Center, using following guidelines:
a) If transport time by ground or air to Trauma Center is less than 30 minutes, patient should go to Trauma Center directly;
b) If transport time to Trauma Center is greater than 30 minutes, determine the difference in transport time between the Trauma Center and the most accessible hospital:
1) If difference is less than 10 minutes, consider transport to Trauma Center;
2) If difference is greater than 10 minutes, consider transport to most accessible hospital;
III. If, upon arrival in the ED,
a) Facility is not a Trauma Center, and;
b) Patient continues to satisfy criteria of Assessments One and Two, and;
c) Patient can be stabilized for further transport, then receiving ED clinician should provide only life-saving procedures (avoiding unnecessary diagnostics) prior to transport to Trauma Center unless he/she judges clinical situation to not warrant such transfer.
TRANSPORT TO TRAUMA SYSTEM PARTICIPATING HOSPITAL
If pre-hospital providers are unable to definitively manage the airway, maintain breathing or support circulation, begin transport to most accessible hospital and simultaneously request ALS intercept and OLMC.
If pre-hospital providers are unable to definitively manage the airway, maintain breathing or support circulation, begin transport to most accessible hospital and simultaneously request ALS intercept and OLMC.
MAINE EMS TRAUMA TRIAGE PROTOCOL
