Citation

van Rein EAJ, Jochems D, Lokerman RD, van der Sluijs R, Houwert RM, Lichtveld RA, van Es MA, Leenen LPH, van Heijl M. Eur. J. Neurol. 2019; 26(2): 274-280.

Affiliation

Department of Surgery, Diakonessenhuis Utrecht/Zeist/Doorn, Utrecht, The Netherlands.

Copyright

(Copyright © 2019, European Federation of Neurological Societies, Publisher John Wiley and Sons)

DOI

10.1111/ene.13804

PMID

30171654

Abstract

INTRODUCTION: Previous studies 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 judgment in the identification of a head injury.

METHODS: In this multicentre cohort study, all trauma patients aged 16 and over, transported with highest priority to a trauma centre, were evaluated. The diagnostic value of EMS provider judgment was determined using the Abbreviated Injury Scale (AIS) of ≥ 1 in the head region as reference standard.

RESULTS: In total, 2,766 patients were included, 980 (35.4%) had a head injury. EMS provider judgment (AIS ≥ 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.

CONCLUSION: Identification of a head injury on-scene is challenging. EMS providers could not identify 32% of the patients with a head injury and 21% 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. This article is protected by copyright. All rights reserved.

This article is protected by copyright. All rights reserved.

Language: en

Keywords

head injury; neurotrauma; prehospital; trauma; triage