A New Resource-Constrained Triage Method Applied to Victims of Penetrating Injury
BACKGROUND:Resource-constrained triage occurs when the number of trauma patients exceeds the capacity for simultaneous transport and treatment. The objective of this article is to apply a new resource-constrained triage method (denoted Sacco triage method [STM]) to victims of penetrating trauma and...
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| Veröffentlicht in: | The Journal of trauma, injury, infection, and critical care injury, infection, and critical care, 2007-08, Vol.63 (2), p.316-325 |
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| container_title | The Journal of trauma, injury, infection, and critical care |
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| creator | Sacco, William J. Navin, D Michael Waddell, Robert K. Fiedler, Katherine E. Long, William B. Buckman, Robert F. |
| description | BACKGROUND:Resource-constrained triage occurs when the number of trauma patients exceeds the capacity for simultaneous transport and treatment. The objective of this article is to apply a new resource-constrained triage method (denoted Sacco triage method [STM]) to victims of penetrating trauma and compare it with existing methods.
METHODS:STM is a mathematical model of resource-constrained triage. Its objective is to maximize expected survivors given constraints on the timing and availability of resources. The model incorporates estimates of time-dependent victim survival probabilities based on initial assessments and expected deteriorations. For application to penetrating trauma, an “RPM” score based on respiratory rate, pulse rate, and best motor response was used to predict survivability. Logistic function-generated survival probability estimates for scene values of RPM were determined from 7,274 penetrating injury patients from the Pennsylvania Trauma Outcome Study. The Delphi Method provided expert consensus on victim deterioration rates, and the model was solved using linear programming. The accuracy of predicting survivability was assessed using calibration and discrimination statistics. STM was compared with START (Simple Triage and Rapid Treatment)-like triage methods with respect to process and outcomes (assessed by expected number of survivors in simulated resource-constrained casualty incidents).
RESULTS:RPM was shown to be an accurate predictor of survival probability for penetrating trauma, equivalent to the Revised Trauma Score and exceeding that of the Injury Severity Score, as measured by calibration and discrimination statistics. In the simulations, STM had substantially more expected survivors than did current triage methods.
CONCLUSIONS:Resource-constrained triage is modeled as an evidence-based, outcome-driven method (STM) that maximizes expected survivors in consideration of resources. STM offers lifesaving and operational advantages over current methods. |
| doi_str_mv | 10.1097/TA.0b013e31806bf212 |
| format | Article |
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METHODS:STM is a mathematical model of resource-constrained triage. Its objective is to maximize expected survivors given constraints on the timing and availability of resources. The model incorporates estimates of time-dependent victim survival probabilities based on initial assessments and expected deteriorations. For application to penetrating trauma, an “RPM” score based on respiratory rate, pulse rate, and best motor response was used to predict survivability. Logistic function-generated survival probability estimates for scene values of RPM were determined from 7,274 penetrating injury patients from the Pennsylvania Trauma Outcome Study. The Delphi Method provided expert consensus on victim deterioration rates, and the model was solved using linear programming. The accuracy of predicting survivability was assessed using calibration and discrimination statistics. STM was compared with START (Simple Triage and Rapid Treatment)-like triage methods with respect to process and outcomes (assessed by expected number of survivors in simulated resource-constrained casualty incidents).
RESULTS:RPM was shown to be an accurate predictor of survival probability for penetrating trauma, equivalent to the Revised Trauma Score and exceeding that of the Injury Severity Score, as measured by calibration and discrimination statistics. In the simulations, STM had substantially more expected survivors than did current triage methods.
CONCLUSIONS:Resource-constrained triage is modeled as an evidence-based, outcome-driven method (STM) that maximizes expected survivors in consideration of resources. STM offers lifesaving and operational advantages over current methods.</description><identifier>ISSN: 0022-5282</identifier><identifier>EISSN: 1529-8809</identifier><identifier>DOI: 10.1097/TA.0b013e31806bf212</identifier><identifier>PMID: 17693830</identifier><language>eng</language><publisher>Hagerstown, MD: Lippincott Williams & Wilkins, Inc</publisher><subject>Biological and medical sciences ; Cause of Death ; Evidence-Based Medicine ; Female ; Humans ; Injuries of the limb. Injuries of the spine ; Injury Severity Score ; Logistic Models ; Male ; Medical sciences ; Models, Theoretical ; Predictive Value of Tests ; Probability ; Sensitivity and Specificity ; Survival Analysis ; Traumas. Diseases due to physical agents ; Triage - methods ; Wounds, Penetrating - classification ; Wounds, Penetrating - mortality ; Wounds, Penetrating - therapy</subject><ispartof>The Journal of trauma, injury, infection, and critical care, 2007-08, Vol.63 (2), p.316-325</ispartof><rights>2007 Lippincott Williams & Wilkins, Inc.</rights><rights>2007 INIST-CNRS</rights><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c3781-c00cab5c6ec4580918e22f7aed549ca3114873093afe233d7c5c9be7727ff84a3</citedby><cites>FETCH-LOGICAL-c3781-c00cab5c6ec4580918e22f7aed549ca3114873093afe233d7c5c9be7727ff84a3</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>314,776,780,27901,27902</link.rule.ids><backlink>$$Uhttp://pascal-francis.inist.fr/vibad/index.php?action=getRecordDetail&idt=18981320$$DView record in Pascal Francis$$Hfree_for_read</backlink><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/17693830$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Sacco, William J.</creatorcontrib><creatorcontrib>Navin, D Michael</creatorcontrib><creatorcontrib>Waddell, Robert K.</creatorcontrib><creatorcontrib>Fiedler, Katherine E.</creatorcontrib><creatorcontrib>Long, William B.</creatorcontrib><creatorcontrib>Buckman, Robert F.</creatorcontrib><title>A New Resource-Constrained Triage Method Applied to Victims of Penetrating Injury</title><title>The Journal of trauma, injury, infection, and critical care</title><addtitle>J Trauma</addtitle><description>BACKGROUND:Resource-constrained triage occurs when the number of trauma patients exceeds the capacity for simultaneous transport and treatment. The objective of this article is to apply a new resource-constrained triage method (denoted Sacco triage method [STM]) to victims of penetrating trauma and compare it with existing methods.
METHODS:STM is a mathematical model of resource-constrained triage. Its objective is to maximize expected survivors given constraints on the timing and availability of resources. The model incorporates estimates of time-dependent victim survival probabilities based on initial assessments and expected deteriorations. For application to penetrating trauma, an “RPM” score based on respiratory rate, pulse rate, and best motor response was used to predict survivability. Logistic function-generated survival probability estimates for scene values of RPM were determined from 7,274 penetrating injury patients from the Pennsylvania Trauma Outcome Study. The Delphi Method provided expert consensus on victim deterioration rates, and the model was solved using linear programming. The accuracy of predicting survivability was assessed using calibration and discrimination statistics. STM was compared with START (Simple Triage and Rapid Treatment)-like triage methods with respect to process and outcomes (assessed by expected number of survivors in simulated resource-constrained casualty incidents).
RESULTS:RPM was shown to be an accurate predictor of survival probability for penetrating trauma, equivalent to the Revised Trauma Score and exceeding that of the Injury Severity Score, as measured by calibration and discrimination statistics. In the simulations, STM had substantially more expected survivors than did current triage methods.
CONCLUSIONS:Resource-constrained triage is modeled as an evidence-based, outcome-driven method (STM) that maximizes expected survivors in consideration of resources. STM offers lifesaving and operational advantages over current methods.</description><subject>Biological and medical sciences</subject><subject>Cause of Death</subject><subject>Evidence-Based Medicine</subject><subject>Female</subject><subject>Humans</subject><subject>Injuries of the limb. Injuries of the spine</subject><subject>Injury Severity Score</subject><subject>Logistic Models</subject><subject>Male</subject><subject>Medical sciences</subject><subject>Models, Theoretical</subject><subject>Predictive Value of Tests</subject><subject>Probability</subject><subject>Sensitivity and Specificity</subject><subject>Survival Analysis</subject><subject>Traumas. Diseases due to physical agents</subject><subject>Triage - methods</subject><subject>Wounds, Penetrating - classification</subject><subject>Wounds, Penetrating - mortality</subject><subject>Wounds, Penetrating - therapy</subject><issn>0022-5282</issn><issn>1529-8809</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2007</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNpdkU9r3DAQxUVpaLZJPkGh6NLcnIwk25KPZmnaQP61bHIVsjzKKvVaW8lmybevwi4EehiGGX7vMbwh5AuDCwaNvFy1F9ABEyiYgrpznPEPZMEq3hRKQfORLAA4Lyqu-DH5nNILAJSlUJ_IMZN1I5SABfnV0jvc0d-YwhwtFsswpikaP2JPV9GbZ6S3OK1DT9vtdvB5OwX65O3kN4kGRx9wxMxPfnym1-PLHF9PyZEzQ8KzQz8hj1ffV8ufxc39j-tle1NYIRUrLIA1XWVrtGWVz2UKOXfSYF-VjTWCsVJJAY0wDrkQvbSVbTqUkkvnVGnECTnf-25j-DtjmvTGJ4vDYEYMc9K1YjVTNWRQ7EEbQ0oRnd5GvzHxVTPQb0nqVav_TzKrvh7s526D_bvmEF0Gvh0Ak6wZXDSj9emdU41igr9x5Z7bhWHCmP4M8w6jXqMZprXOP4FKSFFwAAkqT0UuxsQ_mLqLmA</recordid><startdate>200708</startdate><enddate>200708</enddate><creator>Sacco, William J.</creator><creator>Navin, D Michael</creator><creator>Waddell, Robert K.</creator><creator>Fiedler, Katherine E.</creator><creator>Long, William B.</creator><creator>Buckman, Robert F.</creator><general>Lippincott Williams & Wilkins, Inc</general><general>Lippincott Williams & Wilkins</general><scope>IQODW</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope></search><sort><creationdate>200708</creationdate><title>A New Resource-Constrained Triage Method Applied to Victims of Penetrating Injury</title><author>Sacco, William J. ; Navin, D Michael ; Waddell, Robert K. ; Fiedler, Katherine E. ; Long, William B. ; Buckman, Robert F.</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c3781-c00cab5c6ec4580918e22f7aed549ca3114873093afe233d7c5c9be7727ff84a3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2007</creationdate><topic>Biological and medical sciences</topic><topic>Cause of Death</topic><topic>Evidence-Based Medicine</topic><topic>Female</topic><topic>Humans</topic><topic>Injuries of the limb. Injuries of the spine</topic><topic>Injury Severity Score</topic><topic>Logistic Models</topic><topic>Male</topic><topic>Medical sciences</topic><topic>Models, Theoretical</topic><topic>Predictive Value of Tests</topic><topic>Probability</topic><topic>Sensitivity and Specificity</topic><topic>Survival Analysis</topic><topic>Traumas. Diseases due to physical agents</topic><topic>Triage - methods</topic><topic>Wounds, Penetrating - classification</topic><topic>Wounds, Penetrating - mortality</topic><topic>Wounds, Penetrating - therapy</topic><toplevel>online_resources</toplevel><creatorcontrib>Sacco, William J.</creatorcontrib><creatorcontrib>Navin, D Michael</creatorcontrib><creatorcontrib>Waddell, Robert K.</creatorcontrib><creatorcontrib>Fiedler, Katherine E.</creatorcontrib><creatorcontrib>Long, William B.</creatorcontrib><creatorcontrib>Buckman, Robert F.</creatorcontrib><collection>Pascal-Francis</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>The Journal of trauma, injury, infection, and critical care</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Sacco, William J.</au><au>Navin, D Michael</au><au>Waddell, Robert K.</au><au>Fiedler, Katherine E.</au><au>Long, William B.</au><au>Buckman, Robert F.</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>A New Resource-Constrained Triage Method Applied to Victims of Penetrating Injury</atitle><jtitle>The Journal of trauma, injury, infection, and critical care</jtitle><addtitle>J Trauma</addtitle><date>2007-08</date><risdate>2007</risdate><volume>63</volume><issue>2</issue><spage>316</spage><epage>325</epage><pages>316-325</pages><issn>0022-5282</issn><eissn>1529-8809</eissn><abstract>BACKGROUND:Resource-constrained triage occurs when the number of trauma patients exceeds the capacity for simultaneous transport and treatment. The objective of this article is to apply a new resource-constrained triage method (denoted Sacco triage method [STM]) to victims of penetrating trauma and compare it with existing methods.
METHODS:STM is a mathematical model of resource-constrained triage. Its objective is to maximize expected survivors given constraints on the timing and availability of resources. The model incorporates estimates of time-dependent victim survival probabilities based on initial assessments and expected deteriorations. For application to penetrating trauma, an “RPM” score based on respiratory rate, pulse rate, and best motor response was used to predict survivability. Logistic function-generated survival probability estimates for scene values of RPM were determined from 7,274 penetrating injury patients from the Pennsylvania Trauma Outcome Study. The Delphi Method provided expert consensus on victim deterioration rates, and the model was solved using linear programming. The accuracy of predicting survivability was assessed using calibration and discrimination statistics. STM was compared with START (Simple Triage and Rapid Treatment)-like triage methods with respect to process and outcomes (assessed by expected number of survivors in simulated resource-constrained casualty incidents).
RESULTS:RPM was shown to be an accurate predictor of survival probability for penetrating trauma, equivalent to the Revised Trauma Score and exceeding that of the Injury Severity Score, as measured by calibration and discrimination statistics. In the simulations, STM had substantially more expected survivors than did current triage methods.
CONCLUSIONS:Resource-constrained triage is modeled as an evidence-based, outcome-driven method (STM) that maximizes expected survivors in consideration of resources. STM offers lifesaving and operational advantages over current methods.</abstract><cop>Hagerstown, MD</cop><pub>Lippincott Williams & Wilkins, Inc</pub><pmid>17693830</pmid><doi>10.1097/TA.0b013e31806bf212</doi><tpages>10</tpages></addata></record> |
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| source | MEDLINE; Journals@Ovid Complete |
| subjects | Biological and medical sciences Cause of Death Evidence-Based Medicine Female Humans Injuries of the limb. Injuries of the spine Injury Severity Score Logistic Models Male Medical sciences Models, Theoretical Predictive Value of Tests Probability Sensitivity and Specificity Survival Analysis Traumas. Diseases due to physical agents Triage - methods Wounds, Penetrating - classification Wounds, Penetrating - mortality Wounds, Penetrating - therapy |
| title | A New Resource-Constrained Triage Method Applied to Victims of Penetrating Injury |
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