Citation

He K, Zhang P, Wang SC. Prehosp. Disaster Med. 2019; 34(4): 356-362.

Affiliation

Department of Surgery, Division of Acute Care Surgery, University of Michigan,Ann Arbor, Michigan,USA.

Copyright

(Copyright © 2019, Cambridge University Press)

DOI

10.1017/S1049023X19004515

PMID

31322099

Abstract

INTRODUCTION: With the increasing availability of vehicle telemetry technology, there is great potential for Advanced Automatic Collision Notification (AACN) systems to improve trauma outcomes by detecting patients at-risk for severe injury and facilitating early transport to trauma centers.

METHODS: National Automotive Sampling System Crashworthiness Data System (NASS-CDS) data from 1999-2013 were used to construct a logistic regression model (injury severity prediction [ISP] model) predicting the probability that one or more occupants in planar, non-rollover motor vehicle collisions (MVCs) would have Injury Severity Score (ISS) 15+ injuries. Variables included principal direction of force (PDOF), change in velocity (Delta-V), multiple impacts, presence of any older occupant (≥55 years old), presence of any female occupant, presence of right-sided passenger, belt use, and vehicle type. The model was validated using medical records and 2008-2011 crash data from AACN-enabled Michigan (USA) vehicles identified from OnStar (OnStar Corporation; General Motors; Detroit, Michigan USA) records. To compare the ISP to previously established protocols, a literature search was performed to determine the sensitivity and specificity of first responder identification of ISS 15+ for MVC occupants.

RESULTS: The study population included 924 occupants in 836 crash events. The ISP model had a sensitivity of 72.7% (95% Confidence Interval [CI] 41%-91%) and specificity of 93% (95% CI 92%-95%) for identifying ISS 15+ occupants injured in planar MVCs. The current standard 2006 Field Triage Decision Scheme (FTDS) was 56%-66% sensitive and 75%-88% specific in identifying ISS 15+ patients.

CONCLUSIONS: The ISP algorithm comparably is more sensitive and more specific than current field triage in identifying MVC patients at-risk for ISS 15+ injuries. This real-world field study shows telemetry data transmitted before dispatch of emergency medical systems can be helpful to quickly identify patients who require urgent transfer to trauma centers.

Language: en

Keywords

AACN: Advanced Automotive Collision Notification; ACS COT: American College of Surgeons Committee on Trauma; Abdomen; CDC: Centers for Disease Control and Prevention; CRAMS: Circulation; FTDS: Field Triage Decision Scheme; GPS: Global Positioning System; ISP: injury severity prediction; ISS: Injury Severity Score; MVC: motor vehicle collision; Motor; NASS-CDS: National Automotive Sampling System Crashworthiness Data System; PDOF: principal direction of force; PHI: Prehospital Index; Respiration; SMUR: Service Mobile d’Urgence et Reanimation; T-RTS: Revised Trauma Score for Triage; TS: Trauma Score; and Speech Criteria; Emergency Medical Services; field triage; injury severity; trauma center; vehicle telemetry