Limitations of the Prehospital Index in Identifying Patients in Need of a Major Trauma Center, ,

Study objective: To evaluate the usefulness of the prehospital index (PHI) as a triage tool in a population of trauma patients. Design: Retrospective analysis. Setting: The two adult trauma centers in Calgary, Alberta, Canada, serving a population of 1.2 million. Participants: Six hundred forty-four consecutive patients admitted during an 18-month period with injury severity scores (ISSs) of 16 or more. Results: PHI of 4 or more was statistically related to death within 72 hours of emergency department presentation (P<.00001), emergency surgery within 24 hours (P<.039), emergency surgery within 4 hours (P<.00001), and emergency surgery within 4 hours or death within 72 hours (P<.00001). A more important statistic, however, in the evaluation of a screening tool is sensitivity. PHI of 4 or more had a sensitivity of 98% in identifying mortality but had sensitivity of only 59% for emergency surgery within 24 hours and 71% for emergency surgery within 4 hours. Conclusion: PHI of 4 or more had limitations as a screening tool for triage in our study population because of the high number of patients it categorized as having minor trauma who required emergency surgery. [Plant JR, MacLeod DB, Kortbeek J: Limitations of the prehospital index in identifying patients in need of a major trauma center. Ann Emerg Med August 1995;26:133-137.]