Diagnostic value of emergency medical services provider judgement in the identification of head injuries among trauma patients

Background and purpose Previous studies have reported that many patients with a severe head injury are not transported to a higher‐level trauma centre where the necessary round‐the‐clock neurosurgical care is available. The aim of this study was to analyse the diagnostic value of emergency medical services (EMS) provider judgement in the identification of a head injury. Methods In this multicentre cohort study, all trauma patients aged 16 years and over who were transported with highest priority to a trauma centre were evaluated. The diagnostic value of EMS provider judgement was determined using an Abbreviated Injury Scale score of ≥1 in the head region as reference standard. Results A total of 980 (35.4%) of the 2766 patients who were included had a head injury. EMS provider judgement (Abbreviated Injury Scale score ≥1) had a sensitivity of 67.9% and a specificity of 87.7%. In the cohort, 208 (7.5%) patients had a severe head injury. Of these, 68% were transported to a level I trauma centre. Conclusions Identification of a head injury on‐scene is challenging. EMS providers could not identify 32% of the patients with a head injury and 21% of the patients with a severe head injury. Additional education, training and a supplementary protocol with predictors of a severe head injury could help EMS providers in the identification of these patients.