J
Emerg Med 2001 Nov;21(4):381-6
Should
transient loss of consciousness in blunt head
trauma be a pre-hospital trauma triage criterion?
Horowitz
BZ, Earle OJ.
Oregon
Health Sciences University, Department of
Emergency Medicine, Portland, Oregon 97201, USA.
The
objective of this study was to evaluate
pre-hospital triage of patients with an isolated
brief loss of consciousness (LOC) to a regional
trauma center (RTC). Data from a 6-month period
were retrospectively reviewed from an existing
pre-hospital data collection set. Patients were
included if either they or a witness claimed a LOC,
but they had regained consciousness to at least a
Glasgow Coma Score (GCS) > 13 by the time the
paramedics arrived. Endpoints for need for trauma
center services included positive head computed
tomography (CT) scan, the occurrence of emergency
non-orthopedic surgery in < 6 h, admission to a
surgical intensive care unit (ICU), or a length of
stay (LOS) greater than 3 days for surgical
evaluation. There were 655 complete records
available for 275 cases of vehicular trauma and
380 cases of non-vehicular trauma. There were 170
(62%) patients in the vehicular group, and 287
(76%) in the non-vehicular group evaluated in the
emergency department and discharged. In the
vehicular group, only one (0.4%) patient required
operative intervention in less than 6 h, three
(1.1%) had a positive head CT scan, 10 (3.6%) were
admitted to a surgical ICU, and four (1.5%) had a
LOS > 3 days. In the non-vehicular trauma group,
only one (0.3%) had surgery in < 6 h, eight
(2.1%) had a positive CT scan, six (1.6%) were
admitted to a surgical ICU or had a LOS > 3
days. Overall, 19 (2.9%, CI 0.018-0.045) patients
met any one of the end-point criteria for trauma
center utilization; however, only one patient
(0.2% CI < 0.0001-0.008) required immediate
neurosurgical intervention. Transient LOC, in the
absence of any other American College of Surgeons
(ACS) trauma triage criteria, triaged 97% of
patients to a trauma center, who did not require
trauma center services based on our criteria
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