Applying the Trauma Triage Rule to Blunt Trauma Patients

Objective: To determine the accuracy of the Baxt Trauma Triage Rule (TTR: systolic blood pressure < 85 mm Hg; Glasgow Coma Scale‐motor score < 5; or penetrating trauma to head, neck, or trunk) for prediction of major trauma in an independent data set of blunt trauma patients. Methods: Retrospective evaluation of the TTR in a cohort of patients identified by Oregon Trauma System entry criteria. Accuracy for prediction of “major trauma” victims was measured using resource‐based definitions of major trauma. Participants included 626 adult, blunt trauma patients at a level‐I trauma center serving a metropolitan center of more than one million people. Results: Of 524 patients with sufficient registry data to apply the TTR, 95 (18%) and 63 (12%) patients met the criteria for major trauma suggested by Baxt et al. and Emerman et al., respectively. Using the Baxt definition of major trauma, the TTR had a sensitivity of 74% (95% CI: 0.65–0.83) and a specificity of 84% (95% CI: 0.81–0.88). There were 25 significant false‐negative results, including 12 patients requiring urgent laparoscopy and four patients requiring emergency airway procedures. Using the Emerman definition of major trauma, sensitivity improved modestly to 76% (95% CI: 0.65–0.87) and specificity decreased slightly to 80% (95% CI: 0.77–0.84). Conclusions: In this blunt trauma population, the Baxt TTR failed to identify a significant number of severely injured patients. Slight alterations in the definition of “major trauma” can significantly affect the performance characteristics of triage instruments.