More Evidence MOI is Useless

[Guest guest]

Injury. 2008 Sep;39(9):986-92. Epub 2008 Jul 31. Links

Is mechanism of injury alone a useful predictor of major trauma?

Boyle MJ, EC, Archer F.

Monash University, Department of Community Emergency Health and Paramedic

Practice, Building H, McMahons Road, ston 3199, , Australia.

INTRODUCTION: The Review of Trauma and Emergency Services in -1999

left unresolved the predictive value of mechanism of injury in pre-hospital

trauma triage guidelines. Ethics approval was granted. The objective of this

study is to determine if mechanism of injury alone is a useful predictor of

major trauma in pre-hospital trauma triage.

METHODS: A retrospective cohort study was undertaken of all n

ambulance trauma Patient Care Records (PCRs) for 2002. PCRs where patients

were physiologically stable, had no significant pattern of injury, but had a

significant mechanism of injury were identified and compared with the State

Trauma Registry to determine those patients who sustained hospital defined

major trauma.

RESULTS: There were 4571 incidents of mechanism of injury only, of which 62%

were males, median age was 28 years. Two criteria had statistically

significant results. A fall from greater than 5m (n=52) of whom 5 (RR 10.86,

CI 4.47 to 26.42, P<0.0001) sustained major trauma and a patient trapped

greater than 30min (n=36) of whom 3 (RR 9.0, CI 2.92 to 27.70, P=0003)

sustained major trauma. The overall results are not clinically significant.

CONCLUSION: This study suggests that individual mechanism of injury criteria

have no clinical or operational significance in pre-hospital trauma triage

of patients who have an absence of physiological distress and no significant

pattern of injury. These results add to the knowledge base of trauma

presentation in the pre-hospital setting, especially in Australia, and are

the baseline for further studies.

[Guest guest]

In a message dated 9/4/2008 4:22:14 P.M. Central Daylight Time,

vwickliffe@... writes:

(Street Paramedic already know this) You can not predict injuries base

solely off of MOI.

And the best ones know that fact works both ways.

How many times have you seen someone who too a little slight hit and 2 hours

later they are dead?

Louis N. Molino, Sr., CET

FF/NREMT-B/FSI/EMSI

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[Guest guest]

MOI was something I was taught in my EMT school and even after that

it was almost force fed to us as medics by our educators. It was

shortly after becoming a Paramedic some twenty years ago that I been

watching MOI and how it had no relation with the outcome of the

patient or even what injuries they had. Back then it was almost a

sin to not treat by MOI. But it has been my experience and I'm sure

it is the same for many other working in EMS. The MOI that I was

sure would have killed someone turn out to be the one that everyone

walks away from with not even an injury, and the one that had very

minor MOI where the ones that someone didn't walk away from. So I

learned very early on to rely on my assessment and not MOI. This is

where we should be focusing our attention.

(Street Paramedic already know this) You can not predict injuries

base solely off of MOI.

Teaching good assessment skill will solve several problems that we

currently have in EMS.

1. Over utilization of HEMS.

2. Unreliable use of MOI.

3. The magical 60 minutes ( Golden Hour)

>

> Injury. 2008 Sep;39(9):986-92. Epub 2008 Jul 31. Links

>

> Is mechanism of injury alone a useful predictor of major trauma?

>

> Boyle MJ, EC, Archer F.

>

> Monash University, Department of Community Emergency Health and

Paramedic

> Practice, Building H, McMahons Road, ston 3199, ,

Australia.

>

> INTRODUCTION: The Review of Trauma and Emergency Services in

-1999

> left unresolved the predictive value of mechanism of injury in pre-

hospital

> trauma triage guidelines. Ethics approval was granted. The

objective of this

> study is to determine if mechanism of injury alone is a useful

predictor of

> major trauma in pre-hospital trauma triage.

>

> METHODS: A retrospective cohort study was undertaken of all

n

> ambulance trauma Patient Care Records (PCRs) for 2002. PCRs where

patients

> were physiologically stable, had no significant pattern of injury,

but had a

> significant mechanism of injury were identified and compared with

the State

> Trauma Registry to determine those patients who sustained hospital

defined

> major trauma.

>

> RESULTS: There were 4571 incidents of mechanism of injury only, of

which 62%

> were males, median age was 28 years. Two criteria had statistically

> significant results. A fall from greater than 5m (n=52) of whom 5

(RR 10.86,

> CI 4.47 to 26.42, P<0.0001) sustained major trauma and a patient

trapped

> greater than 30min (n=36) of whom 3 (RR 9.0, CI 2.92 to 27.70,

P=0003)

> sustained major trauma. The overall results are not clinically

significant.

>

> CONCLUSION: This study suggests that individual mechanism of

injury criteria

> have no clinical or operational significance in pre-hospital

trauma triage

> of patients who have an absence of physiological distress and no

significant

> pattern of injury. These results add to the knowledge base of

trauma

> presentation in the pre-hospital setting, especially in Australia,

and are

> the baseline for further studies.

>

[Guest guest]

It's good to see that real research now supports our anecdotal research of " how

not to judge the condition of the patient based on the MOI. "

I have experienced many times in my career where my first impression has been

" OMG! we're gonna need the M.E. " that quickly turned into " get the AMA form

because the patient is on his cellphone over there " As well as those scenes

where you initially think " bring the clipboard " and then end up calling for the

Jaws.

, FF/LP/NREMTP

" Live your life. Respect its brevity. "

FBFD1426@...

Subject: Re: More Evidence MOI is Useless

To: texasems-l

Date: Thursday, September 4, 2008, 9:21 PM

MOI was something I was taught in my EMT school and even after that

it was almost force fed to us as medics by our educators. It was

shortly after becoming a Paramedic some twenty years ago that I been

watching MOI and how it had no relation with the outcome of the

patient or even what injuries they had. Back then it was almost a

sin to not treat by MOI. But it has been my experience and I'm sure

it is the same for many other working in EMS. The MOI that I was

sure would have killed someone turn out to be the one that everyone

walks away from with not even an injury, and the one that had very

minor MOI where the ones that someone didn't walk away from. So I

learned very early on to rely on my assessment and not MOI. This is

where we should be focusing our attention.

(Street Paramedic already know this) You can not predict injuries

base solely off of MOI.

Teaching good assessment skill will solve several problems that we

currently have in EMS.

1. Over utilization of HEMS.

2. Unreliable use of MOI.

3. The magical 60 minutes ( Golden Hour)

>

> Injury. 2008 Sep;39(9):986- 92. Epub 2008 Jul 31. Links

>

> Is mechanism of injury alone a useful predictor of major trauma?

>

> Boyle MJ, EC, Archer F.

>

> Monash University, Department of Community Emergency Health and

Paramedic

> Practice, Building H, McMahons Road, ston 3199, ,

Australia.

>

> INTRODUCTION: The Review of Trauma and Emergency Services in

-1999

> left unresolved the predictive value of mechanism of injury in pre-

hospital

> trauma triage guidelines. Ethics approval was granted. The

objective of this

> study is to determine if mechanism of injury alone is a useful

predictor of

> major trauma in pre-hospital trauma triage.

>

> METHODS: A retrospective cohort study was undertaken of all

n

> ambulance trauma Patient Care Records (PCRs) for 2002. PCRs where

patients

> were physiologically stable, had no significant pattern of injury,

but had a

> significant mechanism of injury were identified and compared with

the State

> Trauma Registry to determine those patients who sustained hospital

defined

> major trauma.

>

> RESULTS: There were 4571 incidents of mechanism of injury only, of

which 62%

> were males, median age was 28 years. Two criteria had statistically

> significant results. A fall from greater than 5m (n=52) of whom 5

(RR 10.86,

> CI 4.47 to 26.42, P<0.0001) sustained major trauma and a patient

trapped

> greater than 30min (n=36) of whom 3 (RR 9.0, CI 2.92 to 27.70,

P=0003)

> sustained major trauma. The overall results are not clinically

significant.

>

> CONCLUSION: This study suggests that individual mechanism of

injury criteria

> have no clinical or operational significance in pre-hospital

trauma triage

> of patients who have an absence of physiological distress and no

significant

> pattern of injury. These results add to the knowledge base of

trauma

> presentation in the pre-hospital setting, especially in Australia,

and are

> the baseline for further studies.

>