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Manual Vital Signs Reliably Predict Need for Life-Saving Interventions in Trauma Patients

Holcomb, John B. MD; Salinas, Jose PhD; McManus, John M. MD, MCR; Miller, Charles C. PhD; Cooke, William H. PhD; Convertino, Victor A. PhD

The Journal of Trauma: Injury, Infection, and Critical Care: October 2005 - Volume 59 - Issue 4 - p 821-829
doi: 10.1097/01.ta.0000188125.44129.7c
Original Articles

Objective: Various types of diagnostic and monitoring techniques are available in the prehospital environment. It is unclear how increasing complexity of diagnostic equipment improves the ability to predict the need for a life-saving intervention (LSI). In this study, we determined whether the addition of diagnostic equipment improved the predictive power of vital signs and scores obtained only by physical examination.

Methods: Institutional review board approval was obtained for an analysis of 793 prehospital trauma patient records collected during helicopter transport by Emergency Medical Services personnel. Exclusion of severe head injuries and patients with incomplete data resulted in 381 patients available for analysis. Data sets were classified on the basis of the instrumentation requirements for capturing the given measurements and were defined by three groups: Group 1, vital signs obtained with no equipment (radial, femoral, and carotid pulse character; capillary refill; motor and verbal components of the Glasgow Coma Scale [GCS]); Group 2, Group 1 plus eye component of the GCS and pulse oximetry (Spo2); and Group 3, Group 2 plus fully automated noninvasive blood pressure measurements, heart rate, end-tidal carbon dioxide, and respiratory rate. LSIs performed during transport and in the hospital were recorded. Data were analyzed using a multivariate logistic regression model to determine which vital signs were the best predictors of LSI.

Results: Radial pulse character and GCS verbal and motor components had the best predictive power for the need of a prehospital LSI in Group 1 (receiver operating characteristic [ROC] curve, 0.97). Radial pulse character together with the eye component of the GCS and the motor component of the GCS provided the best prediction of a need for a prehospital LSI for Group 2 (ROC curve, 0.97). Addition of all supplementary vital signs measured by an automated monitor (Group 3) resulted in an ROC curve of 0.97. Given an abnormal radial pulse character (weak or absent) and abnormal GCS verbal and motor components, the probability of needing an LSI was greater than 88%.

Conclusion: In this cohort of patients, predicting the need for an LSI could have been achieved from GCS motor and verbal components and radial pulse character without automated monitors. These data show that simple and rapidly acquired manual measurements could be used to effectively triage non–head-injured trauma casualties. Similar results were obtained from manual measurements compared with those recorded from automated medical instrumentation that may be unavailable or difficult to use in the field.

From the U.S. Army Institute of Surgical Research (J.B.H., J.S., J.M.M., V.A.C., W.H.C.), Fort Sam Houston, Texas, and the University of Texas Health Science Center (C.C.M.), Houston, Texas.

Submitted for publication May 6, 2005.

Accepted for publication June 13, 2005.

Supported by the United States Army Medical Research and Material Command Combat Casualty Care Research Program (E52-0021-2005-USAISR) and the United States Special Operations Command (MIPR 051-80482).

The opinions or assertions contained herein are the private views of the authors and are not to be construed as official or as reflecting the views of the Department of the Army or the Department of Defense.

Presented at the 18th annual meeting of the Eastern Association for Surgery of Trauma, January, 2005, Fort Lauderdale, Florida.

Address for reprints: COL John B. Holcomb, MD, U.S. Army Institute of Surgical Research, Building 3611, 3400 Rawley E. Chambers, Avenue, Fort Sam Houston, TX 78234-6315; email:

© 2005 Lippincott Williams & Wilkins, Inc.