Risk adjustment measures and outcome measures for prehospital trauma research: recommendations from the emergency medical services outcomes project (EMSOP).
Academic Emergency Medicine · 2011-09-01 · Systematic review
Abstract
OBJECTIVES: The objectives were to conduct a comprehensive, systematic review of the literature for risk adjustment measures (RAMs) and outcome measures (OMs) for prehospital trauma research and to use a structured expert panel process to recommend measures for use in future emergency medical services (EMS) trauma outcomes research. METHODS: A systematic literature search and review was performed identifying the published studies evaluating RAMs and OMs for prehospital injury research. An explicit structured review of all articles pertaining to each measure was conducted using the previously established methodology developed by the Canadian Physiotherapy Association ("Physical Rehabilitation Outcome Measures"). RESULTS: Among the 4,885 articles reviewed, 96 RAMs and/or OMs were identified from the existing literature (January 1958 to February 2010). Only one measure, the Glasgow Coma Scale (GCS), currently meets Level 1 quality of evidence status and a Category 1 (strong) recommendation for use in EMS trauma research. Twelve RAMs or OMs received Category 2 status (promising, but not sufficient current evidence to strongly recommend), including the motor component of GCS, simplified motor score (SMS), the simplified verbal score (SVS), the revised trauma score (RTS), the prehospital index (PHI), EMS provider judgment, the revised trauma index (RTI), the rapid acute physiology score (RAPS), the rapid emergency medicine score (REMS), the field trauma triage (FTT), the pediatric triage rule, and the out-of-hospital decision rule for pediatrics. CONCLUSIONS: Using a previously published process, a structured literature review, and consensus expert panel opinion, only the GCS can currently be firmly recommended as a specific RAM or OM for prehospital trauma research (along with core measures that have already been established and published). This effort highlights the paucity of reliable, validated RAMs and OMs currently available for outcomes research in the prehospital setting and hopefully will encourage additional, methodologically sound evaluations of the promising, Category 2 RAMs and OMs, as well as the development of new measures.
Abstract © the authors or publisher, via PubMed. Reuse and removal
Tags
Triage instruments · Early warning scores · Research methods & trial conduct
Related articles
- Predictive performance of prehospital trauma triage tools for resuscitative interventions within 24 hours in high-risk or life-threatening prehospital trauma patients. (BMC Emerg Med, 2025)
- Accuracy of Trauma on Scene Triage Screening Tool (Shock Index, Reverse Shock Index Glasgow Coma Scale and National Early Warning Score) to Predict the Severity of Emergency Department Triage: A Retrospective Cross-Sectional Study. (Open Access Emerg Med, 2023)
- Diagnostic accuracy of shock index, revised trauma score, and injury severity score for mortality prediction in trauma: A hierarchical meta-analysis. (Injury, 2026)
- Prehospital national early warning score outperforms shock index in predicting mortality and resource utilisation in adult trauma: A systematic review. (Injury, 2026)
- Accuracy of risk tools to predict critical bleeding in major trauma: A systematic review with meta-analysis. (J Trauma Acute Care Surg, 2022)
- "Recommendations for uniform reporting of data following major trauma--the Utstein style" (as of July 17, 1999). An International Trauma Anaesthesia and Critical Care Society (ITACCS). (Acta Anaesthesiol Belg, 2000)