APPLYING THE TRAUMA TRIAGE RULE TO BLUNT TRAUMA PATIENTS

Objective: To determine the accuracy of the Baxt Trauma Triage Rule (T TR: systolic blood pressure < 85 mm Hg; Glasgow Coma Scale-motor score < 5; or penetrating trauma to head, neck, or trunk) for prediction of major trauma in an independent data set of blunt trauma patients. Met hods: Retrospective evaluation of the TTR in a cohort of patients iden tified by Oregon Trauma System entry criteria. Accuracy for prediction of ''major trauma'' victims was measured using resource-based definit ions of major trauma. Participants included 626 adult, blunt trauma pa tients at a level-I trauma center serving a metropolitan center of mor e than one million people. Results: Of 524 patients with sufficient re gistry data to apply the TTR, 95 (18%)and 63 (12%) patients met the cr iteria for major trauma suggested by Baxt et al. and Emerman et al., r espectively. Using the Baxt definition of major trauma, the TTR had a sensitivity of 74% (95% CI:0.65-0.83) and a specificity of 84% (95% CI :0.81-0.88). There were 25 significant false-negative results, includi ng 12 patients requiring urgent laparotomy and four patients requiring emergency airway procedures. Using the Emerman definition of major tr auma, sensitivity improved modestly to 76% (95% CI: 0.65-0.87) and spe cificity decreased slightly to 80% (95% CI:0.77-0.84). Conclusions: In this blunt trauma population, the Baxt TTR failed to identify a signi ficant number of severely injured patients. Slight alterations in the definition of ''major trauma'' can significantly affect the performanc e characteristics of triage instruments.