***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
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    ***EXAMPLES*** 
    Input: Quality control in the treatment of trauma patients often consists in comparisons of survival rates . The trauma population under study is seldom defined with regard to severity of injury . Therefore crude survival rates are of little help when the quality of care is discussed . Trauma scores attempt to summarize the severity of injury of trauma patients in a single number . They attempt to translate differences in the severity of injury into a common language . This study tested the validity of seven common trauma score systems in the setting of Cologne in 1987 . Six hundred and twelve trauma patients treated by physicians at the scene of the accident were prospect ively followed up in 32 hospitals . Final diagnosis , treatment , complications , and survival were evaluated . Sensitivity and specificity in predicting survival were calculated for the following systems : Glasgow Coma Scale , Trauma Score , Revised Trauma Score , Injury Severity Score , TRISS , Prehospital Index , Polytraumaschlüssel . The average time from emergency call to arrival of the emergency physician at the scene of the accident was 6.5 min . Four hundred and one patients ( 65.5 % ) were male . One hundred and thirty-seven patients ( 22.4 % ) suffered from apnoea , 61 ( 10.0 % ) had a systolic blood pressure lower than 90 mmHg , 117 ( 19.1 % ) had had a cardiac arrest and 174 ( 28.4 % ) were unconscious . Four hundred and twenty-three patients ( 69.1 % ) left hospital alive . All trauma score systems tested showed sensitivities and specificities greater than 83 % . They all proved their ability to classify trauma patients according to severity of injury . The TRISS performed best of all , with sensitivity of 93.1 % and specificity of 93.7 % at a cut-off point of 0.85 . ( ABSTRACT TRUNCATED AT 250 WORDS The  prehospital index ( PHI ) is a triage-oriented trauma severity scoring system . This prospect i ve multicenter validation of the PHI was undertaken in response to a favorable pilot study . We applied the PHI to 3,581 patients from 14 different institutions during the period from January 1985 to February 1986 . The PHI was accurate in predicting the need for emergency life-saving surgery within four hours ( P less than .0001 ) and mortality within 72 hours ( P less than .0001 ) following traumatic injury . The curves were generated for PHI versus emergency surgery , mortality , surgery and mortality , injury severity score , and ICU admission rate . These data compare favorably with those from previously published , prospect ively tested , triage-oriented trauma severity scoring systems The Prehospital Index ( PHI ) is a triage-oriented trauma severity scoring system comprising four components : systolic blood pressure , pulse , respiratory status , and level of consciousness , each scored 0 to 5 . The PHI was developed after analysis of 313 cases to provide an objective prehospital scoring system for distinguishing less seriously injured patients ( minor trauma ) from those patients who are likely to die within 72 hours after injury or who require general or neurosurgical operative intervention within 24 hours ( major trauma ) . A PHI of 0 to 3 indicated minor trauma , and a PHI of 4 to 20 signified major trauma . Retrospective analysis of an additional 465 consecutive trauma cases revealed that patients with a PHI of 0 to 3 ( minor trauma ) had a 0 % mortality and a 2 % rate of general or neurosurgical operative intervention . Those with a PHI of 4 to 20 ( major trauma ) carried a 16.4 % mortality and an emergency operative rate of 49.1 % . The PHI was applied prospect ively to 388 consecutive trauma cases presenting to the Butterworth Hospital Emergency Department from October through December 1984 . Of the 351 patients scored as minor trauma in the field , there was a 0 % mortality and only a 0.3 % operative rate . Those scored as major trauma in the field had a mortality of 27 % ( PHI 4 to 7 , 0 % ; PHI 8 to 20 , 53 % ) and an operative rate of 40.5 % ( PHI 4 to 7 , 22 % ; PHI 8 to 20 , 57.9 % ) . These data demonstrate the ability of the PHI to predict mortality ( P less than .001 ) and the need for emergency general or neurosurgical operative intervention ( P less than .001 ) . ( ABSTRACT TRUNCATED AT 250 WORDS OBJECTIVE To assess the interrater reliability of the Glasgow Coma Scale ( GCS ) between nurses and senior doctors in the ED . METHODS This was a prospect i ve observational study with a convenience sample of patients aged 18 or above who presented with a decreased level of consciousness to a tertiary hospital ED . A senior ED doctor ( emergency physicians and trainees ) and registered nurse each independently scored the patient 's GCS in blinded fashion within 15 min of each other . The data were then analysed to determine interrater reliability using the weighted kappa statistic and the size and directions of differences between paired scores were examined . RESULTS A total of 108 eligible patients were enrolled , with GCS scores ranging from 3 to 14 . Interrater agreement was excellent ( weighted kappa > 0.75 ) for verbal scores and total GCS scores , and intermediate ( weighted kappa 0.4 - 0.75 ) for motor and eye scores . Total GCS scores differed by more than two points in 10 of the 108 patients . Interrater agreement did not vary substantially across the range of actual numeric GCS scores . CONCLUSIONS Although the level of agreement for GCS scores was generally high , a significant proportion of patients had GCS scores which differed by two or more points . This degree of disagreement indicates that clinical decisions should not be based solely on single GCS scores BACKGROUND The objective of this study was to combine a physiologic triage score ( prehospital index , PHI ) with criteria regarding mechanism of injury ( MOI ) to increase the efficacy of trauma triage . The specific question being asked was : will the combined score improve the sensitivity and specificity over that of the individual scores ? METHODS In this prospect i ve study , 3,147 injury patients ( all adults > or = 14 years ) were review ed . Each patient received a  PHI score  and a  MOI score  in the field , which were compared with their Injury Severity Score ( ISS ) at separation . An ISS > or = 16 was defined as major trauma . RESULTS PHI alone had a sensitivity of 41 % , MOI alone had a sensitivity of 73 % , whereas the combined PHI/MOI score had a sensitivity of 78 % . All three had similar specificities . These findings were statistically significant ( p < or = 0.001 ) . CONCLUSION The combined PHI/MOI score  was better at identifying those patients with ISS scores > or = 16 compared with the PHI and MOI scores alone . Although this permitted superior triage ( and minimized overtriage ) , the combined score did not identify all major trauma patients STUDY OBJECTIVE To study paramedic judgment and the Trauma Triage Rule in prehospital trauma triage . DESIGN Prospect i ve . SETTING A county emergency medical services system . PARTICIPANTS Six hundred fifty-three trauma patients . RESULTS Over a 3-month period , 653 trauma patients were evaluated in the prehospital setting .  Paramedic judgment and the  Trauma Triage Rule ( TTR )  , as described by Baxt , were evaluated for accuracy in identifying patients requiring trauma center care . The TTR achieved a sensitivity of 88 % and a specificity of 86 % . Paramedic judgment had a sensitivity of 91 % and a specificity of 60 % . Combining the TTR and paramedic judgment achieved a sensitivity of 100 % and a specificity of 75 % . CONCLUSION The TTR and paramedic judgment are effective in identifying patients who require trauma center care in the prehospital setting . The TTR and paramedic judgment combined have the greatest predictive value in identifying seriously injured patients BACKGROUND Respiratory distress is a common symptom of patients transported to hospitals by emergency medical services ( EMS ) personnel . The benefit of advanced life support for such patients has not been established . METHODS The Ontario Prehospital Advanced Life Support ( OPALS ) Study was a controlled clinical trial that was conducted in 15 cities before and after the implementation of a program to provide advanced life support  for patients with out-of-hospital respiratory distress . Paramedics were trained in st and ard advanced life support , including endotracheal intubation and the administration of intravenous drugs . RESULTS The clinical characteristics of the 8138 patients in the two phases of the study were similar . During the first phase , no patients were treated by paramedics trained in advanced life support ; during the second phase , 56.6 % of patients received this treatment .  Endotracheal intubation  was performed in 1.4 % of the patients , and intravenous drugs were administered to 15.0 % during the second phase . This phase of the study was also marked by a substantial increase in the use of nebulized salbutamol and sublingual nitroglycerin for the relief of symptoms . The rate of death among all patients decreased significantly , from 14.3 % to 12.4 % ( absolute difference , 1.9 % ; 95 % confidence interval [ CI ] , 0.4 to 3.4 ; P=0.01 ) from the basic-life-support phase to the advanced-life-support phase ( adjusted odds ratio , 1.3 ; 95 % CI , 1.1 to 1.5 ) . CONCLUSIONS The addition of a specific regimen of out-of-hospital advanced-life-support interventions to an existing EMS system that provides basic life support was associated with a decrease in the rate of death of 1.9 percentage points among patients with respiratory distress OBJECTIVES To improve the Rapid Acute Physiology Score ( RAPS ) as a predictor of in-hospital mortality in the nonsurgical emergency department ( ED ) by including age and oxygen saturation , and to compare this new system ,  Rapid Emergency Medicine Score ( REMS )  , with the Acute Physiology and Chronic Health Examination ( APACHE II ) with reference to predictive accuracy . METHODS This was a prospect i ve cohort study . One hundred sixty-two critically ill patients consecutively admitted to the intensive care unit ( ICU ) during the period of one year , and 865 nonsurgical patients presenting to an adult emergency department ( ED ) and admitted to a medical department of a 1200-bed university hospital during two months , were enrolled . For all entries to the ED , RAPS was calculated and developed to include  noninvasive peripheral oxygen saturation and patient age ( REMS )  , as well as laboratory tests ( APACHE II ) . These scores were calculated for each patient . RESULTS  REMS  was found to be superior to RAPS in predicting in-hospital mortality both in the critically ill patients admitted to the ICU and in the total sample ( area under receiver-operating characteristic curve [ AUC ] 0.910 + /- 0.015 for REMS compared with 0.872 + /- 0.022 for RAPS , p < 0.001 ) . An increase of 1 point in the 26-point REMS scale was associated with an odds ratio of 1.40 for in-hospital death ( 95 % confidence interval = 1.36 to 1.45 , p < 0.0001 ) . The more advanced APACHE II was not found to be superior to REMS ( AUC : 0.901 + /- 0.015 , p = 0.218 ) . CONCLUSIONS RAPS could be improved as a predictor of in-hospital mortality in the nonsurgical ED by including oxygen saturation and patient age to the system . This new scoring system , REMS , had the same predictive accuracy as the well-established , but more complicated , APACHE II STUDY OBJECTIVE We sought to create a clinical decision rule , on the basis of variables available to out-of-hospital personnel , that could be used to accurately predict severe injury in pediatric patients involved in motor vehicle crashes as occupants . METHODS We analyzed the National Automotive Sampling System data base , a national probability sample , using pediatric patients up to 15 years old ( occupants only ) involved in motor vehicle crashes from January 1993 to December 1999 . The National Automotive Sampling System data base includes patients from regions throughout the country , weighted to represent a nationwide sample . Twelve out-of-hospital variables were used in classification and regression tree analysis to create a decision rule separating children with severe injuries ( Injury Severity Score [ ISS ] > or = 16 ) from those with minor injuries ( ISS < 16 ) . Misclassification costs and complexity parameters were selected to yield a decision tree with appropriate sensitivity and specificity for the identification of severely injured patients , while also being simple and practical for out-of-hospital use . Probability weights were used throughout the analysis to account for the sampling design and sampling weights . RESULTS Using a sample size of 8,392 children , we constructed a decision rule using 3 out-of-hospital variables ( Glasgow Coma Scale score , passenger space intrusion > or = 6 in [ > or = 15 cm ] , and restraint use ) to predict those patients with an ISS of 16 or more . Internal cross-validation was used to determine the sensitivity and specificity , yielding values of 92 % and 73 % , respectively , for the prediction of patients with an ISS of 16 or more . CONCLUSION Out-of-hospital variables available to field personnel could be used to effectively triage pediatric motor vehicle crash patients using the decision rule developed 
    Output:
    
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 ) .