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Prehospital Vital Signs Accurately Predict Initial Emergency Department Vital Signs

Published online by Cambridge University Press:  04 March 2020

Marc D. Trust ,
Morgan Schellenberg Open the ORCID record for Morgan Schellenberg [Opens in a new window] ,
Subarna Biswas ,
Kenji Inaba ,
Vincent Cheng ,
Zachary Warriner ,
Bryan E. Love  and
Demetrios Demetriades
Marc D. Trust
Affiliation:
Division of Trauma and Surgical Critical Care, LAC+USC Medical Center, University of Southern California, Los Angeles, CaliforniaUSA
Morgan Schellenberg*
Affiliation:
Division of Trauma and Surgical Critical Care, LAC+USC Medical Center, University of Southern California, Los Angeles, CaliforniaUSA
Subarna Biswas
Affiliation:
Division of Trauma and Surgical Critical Care, LAC+USC Medical Center, University of Southern California, Los Angeles, CaliforniaUSA
Kenji Inaba
Affiliation:
Division of Trauma and Surgical Critical Care, LAC+USC Medical Center, University of Southern California, Los Angeles, CaliforniaUSA
Vincent Cheng
Affiliation:
Division of Trauma and Surgical Critical Care, LAC+USC Medical Center, University of Southern California, Los Angeles, CaliforniaUSA
Zachary Warriner
Affiliation:
Division of Trauma and Surgical Critical Care, LAC+USC Medical Center, University of Southern California, Los Angeles, CaliforniaUSA
Bryan E. Love
Affiliation:
Division of Trauma and Surgical Critical Care, LAC+USC Medical Center, University of Southern California, Los Angeles, CaliforniaUSA
Demetrios Demetriades
Affiliation:
Division of Trauma and Surgical Critical Care, LAC+USC Medical Center, University of Southern California, Los Angeles, CaliforniaUSA
*
Correspondence: Morgan Schellenberg, MD, MPH, FRCSC, Division of Trauma and Surgical Critical Care, LAC + USC Medical Center, University of Southern California, 2051 Marengo Street, Inpatient Tower, C5L100, Los Angeles, California90033USA, E-mail: morgan.schellenberg@med.usc.edu
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Abstract

Introduction:

Prehospital vital signs are used to triage trauma patients to mobilize appropriate resources and personnel prior to patient arrival in the emergency department (ED). Due to inherent challenges in obtaining prehospital vital signs, concerns exist regarding their accuracy and ability to predict first ED vitals.

Hypothesis/Problem:

The objective of this study was to determine the correlation between prehospital and initial ED vitals among patients meeting criteria for highest levels of trauma team activation (TTA). The hypothesis was that in a medical system with short transport times, prehospital and first ED vital signs would correlate well.

Methods:

Patients meeting criteria for highest levels of TTA at a Level I trauma center (2008-2018) were included. Those with absent or missing prehospital vital signs were excluded. Demographics, injury data, and prehospital and first ED vital signs were abstracted. Prehospital and initial ED vital signs were compared using Bland-Altman intraclass correlation coefficients (ICC) with good agreement as >0.60; fair as 0.40-0.60; and poor as <0.40).

Results:

After exclusions, 15,320 patients were included. Mean age was 39 years (range 0-105) and 11,622 patients (76%) were male. Mechanism of injury was blunt in 79% (n = 12,041) and mortality was three percent (n = 513). Mean transport time was 21 minutes (range 0-1,439). Prehospital and first ED vital signs demonstrated good agreement for Glasgow Coma Scale (GCS) score (ICC 0.79; 95% CI, 0.77-0.79); fair agreement for heart rate (HR; ICC 0.59; 95% CI, 0.56-0.61) and systolic blood pressure (SBP; ICC 0.48; 95% CI, 0.46-0.49); and poor agreement for pulse pressure (PP; ICC 0.32; 95% CI, 0.30-0.33) and respiratory rate (RR; ICC 0.13; 95% CI, 0.11-0.15).

Conclusion:

Despite challenges in prehospital assessments, field GCS, SBP, and HR correlate well with first ED vital signs. The data show that these prehospital measurements accurately predict initial ED vitals in an urban setting with short transport times. The generalizability of these data to settings with longer transport times is unknown.

Keywords

ED vital signsprehospital vital signstraumavital signs
Type
Original Research
Information
Prehospital and Disaster Medicine , Volume 35 , Issue 3 , June 2020 , pp. 254 - 259
Copyright
© World Association for Disaster and Emergency Medicine 2020

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References

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. 2012;61(1):1–23.Google Scholar
Rotondo, MF, Cribari, C, Smith, RS (eds). American College of Surgeons Committee on Trauma Resources for Optimal Care of the Injured Patient, 6th ed. Chicago, Illinois USA: American College of Surgeons; 2014.Google Scholar
Bruijns, SR, Guly, HR, Bouamra, O, Lecky, F, Wallis, LA. The value of the difference between ED and prehospital vital signs in predicting outcome in trauma. Emerg Med J. 2014;31(7):579–582.CrossRefGoogle ScholarPubMed
Chen, L, Reisner, AT, Gribok, A, Reifman, J. Exploration of prehospital vital sign trends for the prediction of trauma outcomes. Prehosp Emerg Care. 2009;13(3):286–294.CrossRefGoogle ScholarPubMed
Lipsky, AM, Gausche-Hill, M, Henneman, PL, et al.Prehospital hypotension is a predictor of the need for an emergent, therapeutic operation in trauma patients with normal systolic blood pressure in the emergency department. J Trauma Acute Care Surg. 2006;61(5):1228–1233.CrossRefGoogle ScholarPubMed
Pottecher, J, Ageron, F-X, Fauché, C, et al.Prehospital shock index and pulse pressure/heart rate ratio to predict massive transfusion after severe trauma: retrospective analysis of a large regional trauma database. J Trauma Acute Care Surg. 2016;81(4):713–722.CrossRefGoogle ScholarPubMed
Schellenberg, M, Strumwasser, A, Grabo, D, et al.Delta Shock Index in the emergency department predicts mortality and need for blood transfusion in trauma patients. Am Surg. 2017;83(10):1059–1062.Google ScholarPubMed
Vandromme, MJ, Griffin, RL, Kerby, JD, McGwin, G, Rue, LW, Weinberg, JA.Identifying risk for massive transfusion in the relatively normotensive patient: utility of the prehospital shock index. J Trauma Acute Care Surg. 2011;70(2):384–388.CrossRefGoogle ScholarPubMed
R Benjamin, E, Khor, D, Cho, J, Biswas, S, Inaba, K, Demetriades, D. The age of under-triage: current trauma triage criteria underestimate the role of age and comorbidities in early mortality. J Emerg Med. 2018;55(2):278–287.CrossRefGoogle Scholar
Demetriades, D, Karaiskakis, M, Velmahos, G, et al.Effect on outcome of early intensive management of geriatric trauma patients. Br J Surg. 2002;89(10):1319–1322.CrossRefGoogle ScholarPubMed
Lalezarzadeh, F, Wisniewski, P, Huynh, K, Loza, M, Gnanadev, D.Evaluation of prehospital and emergency department systolic blood pressure as a predictor of in-hospital mortality. Am Surg. 2009;75(10):1009–1014.Google ScholarPubMed
Franklin, GA, Boaz, PW, Spain, DA, Lukan, JK, Carrillo, EH, Richardson, JD. Prehospital hypotension as a valid indicator of trauma team activation. J Trauma Acute Care Surg. 2000;48(6):1034–1037.CrossRefGoogle ScholarPubMed
Arbabi, S, Jurkovich, GJ, Wahl, WL, et al.A comparison of prehospital and hospital data in trauma patients. J Trauma Acute Care Surg. 2004;56(5):1029–1032.CrossRefGoogle ScholarPubMed
Dinh, MM, Oliver, M, Bein, K, et al.Level of agreement between prehospital and emergency department vital signs in trauma patients. Emerg Med Australas. 2013;25:457–463.Google ScholarPubMed