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Diagnostic value of emergency medical services provider judgement in the identification of head injuries among trauma patients
Author(s) -
Rein E. A. J.,
Jochems D.,
Lokerman R. D.,
Sluijs R.,
Houwert R. M.,
Lichtveld R. A.,
Es M. A.,
Leenen L. P. H.,
Heijl M.
Publication year - 2019
Publication title -
european journal of neurology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.881
H-Index - 124
eISSN - 1468-1331
pISSN - 1351-5101
DOI - 10.1111/ene.13804
Subject(s) - medicine , abbreviated injury scale , judgement , head injury , head trauma , emergency medicine , cohort , injury severity score , medical emergency , cohort study , emergency medical services , emergency department , poison control , traumatic brain injury , injury prevention , surgery , psychiatry , political science , law
Background and purpose Previous studies have 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 judgement in the identification of a head injury. Methods In this multicentre cohort study, all trauma patients aged 16 years and over who were transported with highest priority to a trauma centre were evaluated. The diagnostic value of EMS provider judgement was determined using an Abbreviated Injury Scale score of ≥1 in the head region as reference standard. Results A total of 980 (35.4%) of the 2766 patients who were included had a head injury. EMS provider judgement (Abbreviated Injury Scale score ≥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. Conclusions Identification of a head injury on‐scene is challenging. EMS providers could not identify 32% of the patients with a head injury and 21% of the patients 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.