A multicenter validation of the prehospital index.
The prehospital index (PHI) is a triage-oriented trauma severity scoring system. This prospective 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, prospectively tested, triage-oriented trauma severity scoring systems.
Systematic reflection on practice remains a vexed issue for many nurses and the context of a busy hospital environment poses a challenge. As a process to meet this challenge, Grand Rounds is worth considering. Medical practitioners have used this case study-based process over many years almost as a cultural ritual (Myint & Sabanathan, 2005: 297; Wolak, Cairns & Smith, 2008: 176). The format allows exploration of broad topics related to patient care through facilitated discussion with peers (Wolak et al., 2008 p 173). This paper shares how this format was used to encourage ongoing reflective practice, and foster clinical reasoning amongst nurses at The Maitland Hospital.