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Accuracy of the Prehospital Index in Identifying Major Hemorrhage in Trauma Victims

Published online by Cambridge University Press:  28 June 2012

Jeffrey Jones ,
Carol Newman ,
Jon Krohmer  and
Connie Mattice
Jeffrey Jones*
Affiliation:
Emergency Medicine Residency Program and Trauma Registry, Butterworth Hospital, Michigan State University College of Human Medicine, Grand Rapids, Michigan
Carol Newman
Affiliation:
Emergency Medicine Residency Program and Trauma Registry, Butterworth Hospital, Michigan State University College of Human Medicine, Grand Rapids, Michigan
Jon Krohmer
Affiliation:
Emergency Medicine Residency Program and Trauma Registry, Butterworth Hospital, Michigan State University College of Human Medicine, Grand Rapids, Michigan
Connie Mattice
Affiliation:
Emergency Medicine Residency Program and Trauma Registry, Butterworth Hospital, Michigan State University College of Human Medicine, Grand Rapids, Michigan
*
Department of Emergency Medicine, 100 Michigan Ave, NE, Grand Rapids, MI 49503USA
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Abstract

Purpose:

To determine the sensitivity of the Prehospital Index (PHI) in identifying patients with severe blood loss, a one-year review was conducted at a regional trauma facility.

Methods:

The study population consisted of 217 consecutive trauma admissions (ages 3 to 88 years). Patients were managed using standard resuscitation techniques; blood transfusions were ordered at the discretion of attending physicians and did not follow any preplanned protocol. Medical records were examined to determine total blood requiremets for each patient during the first 12 hours of hospitalization, the emergency department (ED) disposition, and final outcome of treatment. The following clinical variables were analyzed (unpaired t-test) to determine their value as predictors of blood loss: age, gender, mechanism of injury, initial vital signs, revised trauma score, PHI, and injury severityscore.

Results:

Forty-two percent (92 patients) received transfusions during the first 12 hours of hospitalization. The best predictor of blood loss was the Prehospital Index. Of the total group, 45% had a PHI >3; 77% (75/98) of these patients required transfusion and received an average of 7.1 units of packed cells. Fifty-five percent (119/217) had a PHI ≤3; 86% (102/119) of these patients did not require transfusion.

Conclusion:

The data suggest that patients with PHI scores >3 require close hemodynamic monitoring to rule out significant blood loss and may warrant immediate cross-matching on arrival to the ED.

Keywords

blood requirementsblood transfusionhemodynamicshemorrhagepredictorsprehospital indexresuscitationtrauma
Type
Original Research
Information
Prehospital and Disaster Medicine , Volume 8 , Issue 3 , September 1993 , pp. 237 - 240
Copyright
Copyright © World Association for Disaster and Emergency Medicine 1993

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