Limitations of the prehospital index in identifying patients in need of a major trauma center.

Abstract

To evaluate the usefulness of the prehospital index (PHI) as a triage tool in a population of trauma patients. Retrospective analysis. The two adult trauma centers in Calgary, Alberta, Canada, serving a population of 1.2 million. Six hundred forty-four consecutive patients admitted during an 18-month period with injury severity scores (ISSs) of 16 or more. PHI of 4 or more was statistically related to death within 72 hours of emergency department presentation (P < .00001), emergency surgery within 24 hours (P < .039), emergency surgery within 4 hours (P < .00001), and emergency surgery within 4 hours or death within 72 hours (P < .0001). A more important statistic, however, in the evaluation of a screening tool is sensitivity. PHI of 4 or more had a sensitivity of 98% in identifying mortality but had sensitivity of only 59% for emergency surgery within 24 hours and 71% for emergency surgery within 4 hours. PHI of 4 or more had limitations as a screening tool for triage in our study population because of the high number of patients it categorized as having minor trauma who required emergency surgery.