Table 2.
Predictive value of REACT-2 immediate total-body CT criteria for severe injuries, n = 1083
| n | PPV, % (95% CI) | NPV, %* (95% CI) | Sens, %* (95% CI) | Spec, %* (95% CI) | |
|---|---|---|---|---|---|
| Parameters at hospital arrival | |||||
| Respiratory rate ≥ 30/min or ≤ 10/min | 16 | 81 (62–100) | 24 (21–26) | 2 (1–2) | 99 (98–100) |
| Pulse ≥ 120/min | 69 | 80 (70–89) | 24 (21–27) | 7 (5–8) | 95 (92–97) |
| Pulse ≥ 130/min† | 49 | 88 (79–97) | 24 (22–27) | 5 (4–7) | 98 (96–100) |
| Pulse ≥ 140/min† | 26 | 88 (63–76) | 24 (21–27) | 3 (2–4) | 99 (98–100) |
| Systolic blood pressure ≤ 100 mmHg | 116 | 96 (92–99) | 26 (23–29) | 13 (11–16) | 98 (96–100) |
| Systolic blood pressure < 90 mmHg† | 82 | 100 (100–100) | 26 (23–28) | 10 (8–12) | 100 (100–100) |
| Systolic blood pressure < 80 mmHg† | 32 | 100 (100–100) | 24 (22–27) | 4 (3–5) | 100 (100–100) |
| Estimated exterior blood loss ≥ 500 ml | 43 | 91 (82–99) | 24 (22–27) | 5 (3–6) | 98 (97–100) |
| GCS ≤ 13 or abnormal pupillary reaction | 485 | 93 (91–95) | 37 (33–41) | 55 (51–58) | 87 (83–91) |
| GCS ≤ 8† | 437 | 99 (98–100) | 39 (35–43) | 52 (49–56) | 98 (97–100) |
| GCS = 3† | 394 | 99 (99–100) | 37 (33–41) | 47 (44–51) | 99 (98–100) |
| Clinical suspicions | |||||
| Fractures from at least two long bones | 90 | 89 (82–95) | 25 (22–28) | 10 (8–12) | 96 (94–99) |
| Flail chest, open chest, or multiple rib fractures | 114 | 83 (76–90) | 25 (22–27) | 12 (9–14) | 93 (89–96) |
| Severe abdominal injury | 65 | 82 (72–91) | 24 (21–27) | 6 (5–8) | 95 (93–98) |
| Pelvic fracture | 98 | 78 (69–86) | 24 (21–27) | 9 (7–11) | 91 (88–95) |
| Unstable vertebral fractures/spinal cord compression | 69 | 68 (57–79) | 23 (21–26) | 6 (4–7) | 91 (88–95) |
| Injury mechanisms | |||||
| Fall from height (> 3 m/> 10 ft) | 319 | 62 (57–67) | 18 (15–20) | 24 (21–27) | 53 (47–59) |
| Fall from height (> 4 m/> 13 ft)† | 166 | 70 (64–77) | 23 (20–25) | 14 (12–17) | 81 (76–86) |
| Fall from height (> 5 m/> 16 ft)† | 126 | 71 (64–79) | 23 (20–26) | 11 (9–13) | 86 (82–90) |
| Fall from height (> 6 m/> 20 ft)† | 82 | 78 (69–87) | 24 (21–26) | 8 (6–10) | 93 (90–96) |
| Fall from height (> 7 m/> 23 ft)† | 60 | 87 (78–95) | 24 (22–27) | 6 (5–8) | 97 (95–99) |
| Fall from height (> 8 m/> 26 ft)† | 40 | 88 (77–98) | 24 (22–27) | 4 (3–6) | 98 (96–100) |
| Ejection from a vehicle | 30 | 60 (42–78) | 23 (21–26) | 2 (1–3) | 95 (93–98) |
| Death of occupant in same vehicle | 17 | 65 (42–87) | 24 (21–26) | 1 (1–2) | 98 (96–100) |
| Severely injured patient in same vehicle | 18 | 78 (59–97) | 24 (21–26) | 2 (1–3) | 98 (97–100) |
| Wedged or trapped chest/abdomen | 60 | 83 (74–93) | 24 (21–27) | 6 (4–8) | 96 (94–99) |
*Within the group of patients selected by the original criteria
†Retrospectively adjusted criteria
GCS Glasgow Coma Scale, PPV positive predictive value, NPV negative predictive value, Sens sensitivity, Spec specificity, CI confidence interval