Évaluation préhospitalière de la gravité des traumatisés

Annales françaises de médecine d'urgence - Tập 1 - Trang 33-42 - 2010
B. Vivien1, M. Raux2, B. Riou3
1Samu 75 et département d’anesthésie-réanimation, CHU Necker-Enfants-Malades, Assistance publique-Hôpitaux de Paris (AP-HP), université Paris-Descartes-Paris-V, Paris, France
2Salle de surveillance post-interventionnelle et d’accueil des polytraumatisés, départment d’anesthésie réanimation, CHU Pitié-Salpêtrière, université Pierre-et-Marie-Curie — Paris-VI, Paris, France
3Service d’accueil des urgences, CHU Pitié-Salpêtrière, AP-HP, université Pierre-et-Marie-Curie-Paris-VI, Paris, France

Tóm tắt

L’évaluation de la gravité des traumatisés représente une étape fondamentale de leur prise en charge initiale. Elle constitue à la fois un élément pronostique et d’orientation (triage) des blessés. Cette évaluation porte sur les pathologies associées, le type de traumatisme, les variables physiologiques et les lésions anatomiques. Ces éléments sont intégrés, tout ou partie, dans les algorithmes de prise en charge comme celui de Vittel ou dans le calcul de différents scores évaluant la gravité. Principalement construits à partir de cohortes de patients nord-américains, c’est-à-dire dont la prise en charge préhospitalière diffère de celle de patients européens, il convient d’être prudent dans l’utilisation de ces scores en Europe. Tous ne peuvent être calculés au chevet du patient, et donc aider à leur triage, faute d’informations disponibles ou en raison de la complexité des calculs. Nous proposons donc d’utiliser au cours de la phase préhospitalière le score MGAP (Mécanisme, score de Glasgow, âge, pression artérielle), parce qu’il est simple, performant et qu’il prend en compte l’âge et le mécanisme du traumatisme. Toutefois, il n’est probablement pas souhaitable de se limiter à l’utilisation unique d’un score quel qu’il soit, et l’intégration du score MGAP au sein de l’algorithme de triage de Vittel reste à définir.

Tài liệu tham khảo

MacKenzie EJ, Rivara FP, Jurkovich GJ, et al (2006) A national evaluation of the effect of trauma center care on mortality. N Engl J Med 354:366–378 Garwe T, Cowan LD, Neas BR, et al (2010) Directness of transport of major trauma patients to a level 1 trauma center: a propensity-adjusted analysis of the impact on short-term mortality. J Trauma 69:[in press] Barriere SL, Lowry SF (1995) An overview of mortality risk prediction in sepsis. Crit Care Med 23:376–393 Yates DW (1990) Scoring systems for trauma. Br Med J 301:1090–1094 Riou B, Landais P, Vivien B, et al (2001) The distribution of the probability of survival is a strategic issue in randomized trial in trauma. Anesthesiology 95:56–63 Boyd CR, Tolson MA, Copes WS (1987) Evaluation trauma care: the TRISS method. J Trauma 27:370–378 Peytel E, Menegaux F, Cluzel P, et al (2001) Initial imaging assessment in severe blunt trauma. Intensive Care Med 27:1756–1761 Ray P, Le Manach Y, Riou B, et al (2010) Statistical evaluation of a biomarker. Anesthesiology 112:1023–1040 Sasser SM, Hunt RC, Sullivent EE, et al (2009) Guidelines for field triage of injured patients recommendations of the National Expert Panel on Field Triage. MMWR 58:1–35 Sartorius D, Le Manach Y, David JS, et al (2010) Mechanism, Glasgow Coma Scale, Age, and Arterial Pressure (MGAP): a new simple prehospital triage score to predict mortality in trauma patients. Crit Care Med 38:831–837 Kann SH, Hougaard K, Christensen EF (2007) Evaluation of prehospital trauma triage criteria: a prospective study at a Danish level 1 trauma centre. Acta Anaesthesiol Scand 51:1172–1177 Champion HR, Copes WS, Sacco WJ, et al (1990) A new characterization of injury severity. J Trauma 30:539–545 Rooke GA, Reves JG, Rosow C (2002) Anesthesiology and geriatric medicine. Anesthesiology 96:2–4 MacKenzie EJ, Morris JA, Edelstein SL (1989) Effects of pre-existing disease on length of hospital stay in trauma patients. J Trauma 29:757–764 Raux M, Thicoïpé M, Wiel E, et al (2006) Comparison of respiratory rate and peripheral oxygen saturation to assess severity in trauma patients. Intensive Care Med 32:405–412 Baxt W, Jones J, Fortlage D (1991) The Trauma Triage Rule: a new resource-based approach to the prehospital identification of major trauma victims. Ann Emerg Med 19:1404–1406 Teasdale G, Jennett B (1974) Assessment of coma and impaired consciousness: a practical scale. Lancet 2:81–84 Compagnone C, d’Avella D, Servadei F, et al (2009) Patients with moderate head injury: a prospective multicenter study of 315 patients. Neurosurgery 64:690–696 Rutledge R, Lentz CW, Faklry S, et al (1998) Appropriate use of the Glasgow Coma Scale in intubated patients: a linear regression prediction of the Glasgow verbal score from eye and motor scene. J Trauma 41:514–522 Gill M, Reiley DG, Green SM (2004) Interrater reliability of Glasgow Coma Scale scores in the emergency department. Ann Emerg Med 43:215–223 Teoh LSG, Gowardman JR, Larsen PD, et al (2000) Glasgow Coma Scale: variation in mortality among permutations of specific total scores. Intensive Care Med 26:157–161 Healey C, Osler TM, Rogers FB, et al (2003) Improving the Glasgow Coma Scale score: motor score alone is a better predictor. J Trauma 54:671–680 Rutledge R, Lentz CW, Fakhry S, et al (1996) Appropriate use of the Glasgow Coma Scale in intubated patients: a linear regression prediction of the Glasgow verbal score from the Glasgow eye and motor scores. J Trauma 41:514–522 Ross SE, Leipold C, Terregino C, et al (1998) Efficacy of the motor component of the Glasgow Coma Scale in trauma triage. J Trauma 45:42–44 Champion HR, Sacco WJ, Copes WS, et al (1989) A revision of the Trauma Score. J Trauma 29:623–629 Champion HR, Sacco WJ (1980) Assessment of injury severity: the Triage Index. Crit Care Med 8:201–208 Champion HR, Sacco WJ (1980) An anatomic index of injury severity. J Trauma 20:197–202 Champion HR, Sacco WJ, Carnazzo AJ, et al (1981) Trauma Score. Crit Care Med 9:672–676 Harviel JD, Landsman I, Greenberg A, et al (1989) The effect of autopsy on injury severity and survival probability calculations. J Trauma 9:766–772 Copes WS, Champion HR, Sacco WJ, et al (1988) The Injury Score Revisited. J Trauma 28:69–76 Copes WS, Champion HR (1990) Progress in characterizing anatomic injury. J Trauma 30:1200–1207 Baker SP, O’Neil B, Haddon W, et al (1974) A method for describing patients with multiple injuries and evaluating emergency care. J Trauma 14:187–196 Baker SP, O’Neil B (1976) The Injury Severity Score: an update. J Trauma 16:882–885 Champion HR, Copes WS (1990) A new characterization of injury severity. J Trauma 30:539–546 Hollis S, Yates DW, Woodford M, et al (1995) Standardized comparison of performance indicators in trauma: a new approach to case-mix variation. J Trauma 38:763–766 Champion HR, Copes WS (1990) The Major Trauma Outcome Study: establishing national norms for trauma care. J Trauma 30:1356–1365 Demetriades D, Chan LS, Velmahos G, et al (1998) TRISS methodology in trauma: the need for alternatives. Br J Surg 85:379–384 Yates D, Carli P, Woodford M, et al (1994) Towards statistical comparison of French and British systems of trauma care. JEUR 2:88–93 Rutledge R, Osler T, Emery S, et al (1998) The end of the Injury Severity Score (ISS) and the Trauma and Injury Severity Score (TRISS): ICISS, an International Classification of Diseases, ninth revision-based prediction tool, outperforms both ISS and TRISS as predictors of trauma patient survival, hospital charges, and hospital length of stay. J Trauma 44:41–49 Osler TM, Cohen M, Rogers FB, et al (1997) Trauma registry injury coding is superflous: a comparison of outcome prediction based on trauma registry International Classification of Diseases-Ninth Revision (ICD-9) and hospital information systems ICD-9 codes. J Trauma 43:253–256 Raux M, Sartorius D, Le Manach Y, et al (2010) What do prehospital trauma scores predict besides mortality? J Trauma 70:[in press] Bond RJ, Korbeek JB, Preshaw RM (1997) Field trauma triage combining mechanism of injury with the prehospital index for an improved trauma triage tool. J Trauma 43:283–287 Emerman CL, Shade B, Kubincanek J (1991) A comparison of EMT judgment and pre-hospital trauma triage instruments. J Trauma 31:1369–1375 American College of Surgeon’s Committee on Trauma (1990) ASCOT. Resources for optimal care of the injured patient. American College of Surgeons Ed, Chicago Riou B, Thicoïpé M, Atain-Kouadio P, et al (2002) Comment évaluer la gravité ? In: Samu de France ed. Actualités en réanimation préhospitalière: le traumatisé grave. SFEM Editions, Paris, pp 115–128 Le Noël A, Raux M, Nicolas-Robin A, et al (2010) Critères d’acceptation des patients polytraumatisés en centre spécialisé. Société française d’anesthésie et de réanimation: www.sfar.org (accès le 2 octobre 2010)