Validation and Refinement of a Rule to Predict Emergency Intervention in Adult Trauma Patients
Haukoos JS, Byyny RL, Erickson C, Paulson S, Hopkins E, Sasson C, Bender B, Gravitz CS, Vogel JA, Colwell CB, Moore EE.
This retrospective validation of two existing clinical decision rules, the Loma Linda rule and the American College of Surgeons’ Major Resuscitation Criteria, found that the Loma Linda rule offered the best sensitivity (95.6%) when compared with the ACS criteria (85.5%). JC attendees were concerned at the lack of rigorous evaluation of potential predictor variables or statistical assessment of significance when related to the outcome. Further, the group felt that these clinical decision rules are not as useful in a Canadian centre where penetrating trauma is less frequently encountered and the need for emergent operation or procedure (thoracotomy, cesarean, or cricothyroidotomy) within one hour is infrequently required.