Motor Vehicle Intrusion Alone Does Not Predict Trauma Center Admission or Use of Trauma Center Resources

BACKGROUND: The Centers for Disease Control and Prevention (CDC) published its Guidelines for Field Triage of Injured Patients in 2009. These CDC guidelines define criteria for the triage of trauma patients to trauma centers, and include physiologic, anatomic, and high-risk mechanism-of-injury criteria. One of the mechanism criteria used for motor vehicle crashes (MVCs) is intrusion >12 inches at the occupant site or >18 inches at any site. Objective. We hypothesized that motor vehicle intrusion, as the sole criterion for transport to a trauma center, is neither sensitive nor specific for predicting which patients will utilize trauma center resources. METHODS: This was a retrospective, observational study of a cohort of MVC victims transported to a single trauma center. The authors extracted MVC characteristics, patient demographics, and final diagnoses from emergency medical services (EMS) and emergency department (ED) charts. Two outcomes were examined: admission to the trauma center for a traumatic injury and use of trauma center resources, defined as in-hospital death, admission to an intensive care unit, operative intervention of any type, spinal injury, or intracranial hemorrhage. RESULTS: During the 18-month study period, 608 patients met the inclusion criteria in our study; 36 patients met the trauma center triage criteria based solely on intrusion. The sensitivity, specificity, and positive predictive value (PPV) of intrusion were 38.9%, 92.8%, and 25.5%, respectively, for trauma center admission, and 58.3%, 91.9%, and 12.7%, respectively, for trauma center resource utilization. We conducted one post hoc adjustment to modify intrusion to entrapment. This change greatly increased the PPV of the CDC guidelines for both trauma center admissions and trauma center utilization, without any reduction in sensitivity. CONCLUSIONS: Motor vehicle intrusion alone is a poor predictor of the need for trauma center admission or trauma center resource utilization. A modest change to the CDC guidelines from intrusion to entrapment may reduce overtriage while maintaining a high sensitivity for serious injury.