Eastes L S, Norton R, Brand D, Pearson S, Mullins R J
Trauma Program, UHN-66, Oregon Health Sciences University, 3181 S.W. Sam Jackson Park Road, Portland, OR 97201, USA.
J Trauma. 2001 May;50(5):908-13. doi: 10.1097/00005373-200105000-00022.
This study evaluated processes of care and outcome for injured patients at a Level I trauma center who had been either treated as a full trauma team activation (FULL) or managed with a modified trauma team activation (MOD).
A retrospective methodology was used to evaluate all patients entered into the regional trauma system and transported from the scene to a Level I trauma center. Patients treated during a 2-year period of exclusively FULL trauma team protocols were compared with patients managed during a subsequent 2-year period after implementation of a two-tiered response. In the later era, trauma system patients were designated before hospital arrival as either FULL or MOD trauma team responses. An additional case-control analysis was conducted on a subset of MOD trauma team response patients who were undertriaged; that is, in retrospect, they met criteria for a FULL response. The outcomes in the case-control group were compared by chi2 tests and Mann-Whitney U tests. Statistical significance was assumed for p < 0.05.
During the presystem period, 1,740 patients were transported as trauma system entries to Oregon Health Sciences University. During the postsystem period, 2,333 patients were transported to Oregon Health Sciences University as either MOD trauma system entries (1,272 [55%]) or as FULL trauma system entries (1,061 [45%]). Postsystem patients had longer time intervals in the emergency department compared with presystem patients. Death rates for patients who died in the emergency department or before hospital discharge were similar. Among patients who were designated as MOD trauma system entries and were subsequently categorized as meeting FULL trauma team criteria, mortality rate was low.
Implementation of the tiered response protocol led to a substantial change in the operational response in the emergency department. Although processes of care were nominally prolonged, adverse consequences were not identified. We concluded from this quality improvement review that implementation of a tiered response protocol was satisfactory and improved efficiency. Further work is required to improve accuracy of the categorization of trauma system patients as either MOD or FULL trauma codes.
本研究评估了在一级创伤中心，接受全创伤团队启动（FULL）治疗或采用改良创伤团队启动（MOD）管理的受伤患者的护理过程及结果。
采用回顾性方法评估所有进入区域创伤系统并从现场转运至一级创伤中心的患者。将在仅采用全创伤团队方案的2年期间接受治疗的患者与在实施两级响应后的后续2年期间接受管理的患者进行比较。在后期，创伤系统患者在入院前被指定为全创伤团队或改良创伤团队响应。对一组分类不足的改良创伤团队响应患者进行了额外的病例对照分析；也就是说，回顾来看，他们符合全创伤团队响应的标准。通过卡方检验和曼 - 惠特尼U检验比较病例对照组的结果。当p < 0.05时认为具有统计学意义。
在系统建立前的时期，有1740名患者作为创伤系统病例被转运至俄勒冈健康科学大学。在系统建立后的时期，有2333名患者作为改良创伤系统病例（1272例[55%]）或全创伤系统病例（1061例[45%]）被转运至俄勒冈健康科学大学。与系统建立前的患者相比，系统建立后的患者在急诊科的停留时间更长。在急诊科死亡或在出院前死亡的患者死亡率相似。在被指定为改良创伤系统病例且随后被归类为符合全创伤团队标准的患者中，死亡率较低。
分级响应方案的实施导致急诊科的操作响应发生了重大变化。虽然护理过程名义上延长了，但未发现不良后果。我们从这项质量改进评估中得出结论，分级响应方案的实施是令人满意的，并且提高了效率。需要进一步开展工作以提高将创伤系统患者分类为改良或全创伤代码的准确性。
