Hoff W S, Tinkoff G H, Lucke J F, Lehr S
Department of Surgery, Lehigh Valley Hospital Center, Allentown, Pennsylvania.
J Trauma. 1992 Sep;33(3):408-12. doi: 10.1097/00005373-199209000-00012.
Overtriage (i.e.; transport of patients with minimal injuries to a trauma center) has been accepted as necessary to avoid missing clinically significant injuries. We reviewed our experience with 344 patients (ISS less than or equal to 4) who were admitted to a level I trauma center during a 2-year period. The trauma team was activated for 209 patients (TA), and emergency department referrals accounted for 135 (ED). One hundred seventy-three patients (TA = 64%, ED = 36%) met American College of Surgeons' Committee on Trauma (ACSCOT) field triage criteria (FTC). Mechanism of injury, especially ejection from a motor vehicle, was the most frequently utilized FTC indicator. We found no differences between the TA and ED groups relative to Trauma Score, Glasgow Coma Scale score, Injury Severity Score, length of stay, or ICU days. Mean total costs were higher for the TA group than for the ED group. The TA group had a higher nursing acuity level than the ED group. Compliance with FTC yields an inherent overtriage of minimally injured patients; however, noncompliance with FTC compounds the overtriage rate. Failure to comply with FTC is costly, labor intensive, and may represent misuse of the trauma system. We propose continual re-education of prehospital personnel, increased responsibility of all hospitals in the trauma center catchment area, and protocols for "downstaging" trauma resuscitation in minimally injured patients.
过度分诊（即：将轻伤患者转运至创伤中心）已被认为是避免漏诊具有临床意义损伤的必要措施。我们回顾了在两年期间被收治于一级创伤中心的344例患者（损伤严重度评分小于或等于4）的情况。创伤团队为209例患者启动（TA组），急诊科转诊患者为135例（ED组）。173例患者（TA组占64%，ED组占36%）符合美国外科医师学会创伤委员会（ACSCOT）现场分诊标准（FTC）。损伤机制，尤其是从机动车中被抛出，是最常被使用的FTC指标。我们发现TA组和ED组在创伤评分、格拉斯哥昏迷量表评分、损伤严重度评分、住院时间或重症监护病房天数方面没有差异。TA组的平均总费用高于ED组。TA组的护理敏锐度水平高于ED组。遵守FTC会导致对轻伤患者的固有过度分诊；然而，不遵守FTC会使过度分诊率更高。不遵守FTC成本高昂、劳动强度大，可能意味着对创伤系统的滥用。我们建议对院前人员进行持续再教育，增加创伤中心服务区域内所有医院的责任，并制定针对轻伤患者“降级”创伤复苏的方案。
