Citation

Newgard CD, Cheney TP, Chou R, Fu R, Daya MR, O'Neil ME, Wasson N, Hart EL, Totten AM. Acad. Emerg. Med. 2020; ePub(ePub): ePub.

Affiliation

Department of Medical Informatics and Clinical Epidemiology, Oregon Health & Science University, Portland, Oregon, USA.

Copyright

(Copyright © 2020, Society for Academic Emergency Medicine, Publisher John Wiley and Sons)

DOI

10.1111/acem.14056

PMID

32558073

Abstract

STUDY OBJECTIVE: To systematically identify and summarize out-of-hospital measures of circulatory compromise as diagnostic predictors of serious injury, focusing on measures usable by emergency medical services (EMS) to inform field triage decisions.

METHODS: We searched Ovid MEDLINE^® , CINAHL^® , and the Cochrane databases from 1996 through August 2017 for published literature on individual circulatory measures in trauma. We reviewed reference lists of included articles for additional relevant citations. Measures of diagnostic accuracy included: sensitivity, specificity, and area under the receiver operating characteristic curve (AUROC). Indicators of serious injury included: resource need; serious anatomic injury; and mortality. We pooled estimates when data permitted.

RESULTS: We identified 114 articles, reporting results of 111 studies. Measures included systolic blood pressure (SBP), heart rate (HR), shock index, lactate, base deficit, and heart rate variability. Pooled out-of-hospital sensitivity estimates were: SBP <90 mmHg 19% (95% CI 12 to 29%); HR ≥110 bpm 28% (95% CI 20 to 37%); shock index >0.9 37% (95% CI 22 to 56%); and lactate >2.0 mmol/L 74% (95% CI 48 to 90%). Pooled specificity estimates were: SBP <90 mmHg 95% (95% CI 91 to 97%); HR ≥110 bpm 85% (95% CI 74 to 91%); shock index >0.9 85% (95% CI 72 to 92%); and lactate >2.0 mmol/L 62% (95% CI 51 to 72%). Pooled AUROCs included: SBP 0.67 (95% CI 0.58 to 0.75); HR 0.67 (95% CI 0.56 to 0.79); shock index 0.72 (95% CI 0.66 to 0.77); and lactate 0.77 (95% CI 0.67 to 0.82). Strength of evidence was low to moderate.

CONCLUSIONS: Out-of-hospital circulatory measures are associated with poor to fair discrimination for identifying trauma patients with serious injuries. Many seriously injured patients have normal circulatory measures (low sensitivity), but when present, the measures are highly specific for identifying patients with serious injuries.

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Language: en

Keywords

blood pressure; circulatory measures; emergency medical services; heart rate; trauma; triage