Ciesla David J, Sava Jack A, Street James H, Jordan Marion H
Department of Surgery, Washington Hospital Center, Washington, DC 20005, USA.
J Am Coll Surg. 2008 Jan;206(1):131-7. doi: 10.1016/j.jamcollsurg.2007.06.285. Epub 2007 Sep 17.
Trauma systems are designed to bring the injured patient to definitive care in the shortest practical time. This depends on prehospital destination criteria (primary triage) and interfacility transfer guidelines (secondary triage). Although primary undertriage is associated with increased costs and worse outcomes for selected injuries, secondary overtriage can overwhelm system resources and delay definitive care. The purpose of this study was to determine the incidence of secondary overtriage in a region without a formal trauma system.
Retrospective cohort study of trauma registry data at an American College of Surgeons Committee on Trauma-verified Level I trauma center and regional referral center. Secondary overtriage was defined as patients transferred from another hospital emergency department to our trauma receiving unit who had an injury severity score < 10, did not require an operation, and who were discharged to home within 48 hours of admission.
Data on 9,064 patients were reviewed; 6,875 (76%) arrived directly from the scene and 2,189 (24%) were transferred. Although the transferred group was more severely injured, the majority (64%) had minor injuries and 824 (39%) met secondary overtriage criteria. The degree of secondary overtriage and injury pattern varied with respect to referring facility. Peak admission day and times for overtriage patients coincided with scene admissions trauma receiving unit closure events. Patient payor mix and facility cost and reimbursement profiles did not differ between scene and transfer overtriage patients.
A substantial proportion of transferred trauma patients require only brief diagnostic or observational care. Excessive overtriage calls for development of a regional inclusive trauma system with established primary and secondary triage guidelines to improve access to care and trauma system efficiency.
创伤系统旨在在最短的实际时间内为受伤患者提供确定性治疗。这取决于院前目的地标准（初级分诊）和机构间转运指南（二级分诊）。虽然初级分诊不足会导致特定损伤的成本增加和预后变差，但二级过度分诊会使系统资源不堪重负，并延迟确定性治疗。本研究的目的是确定在一个没有正式创伤系统的地区二级过度分诊的发生率。
对美国外科医师学会创伤委员会认证的一级创伤中心和区域转诊中心的创伤登记数据进行回顾性队列研究。二级过度分诊定义为从另一家医院急诊科转至我们创伤接收单元的患者，这些患者的损伤严重程度评分<10，不需要手术，且在入院后48小时内出院回家。
对9064例患者的数据进行了审查；6875例（76%）直接从现场送来，2189例（24%）为转运患者。虽然转运组受伤更严重，但大多数（64%）为轻伤，824例（39%）符合二级过度分诊标准。二级过度分诊的程度和损伤类型因转诊机构而异。过度分诊患者的入院高峰日和时间与现场入院创伤接收单元关闭事件一致。现场和转运过度分诊患者的患者支付方构成、机构成本和报销情况没有差异。
相当一部分转运的创伤患者仅需要简短的诊断或观察护理。过度的过度分诊要求建立一个具有既定初级和二级分诊指南的区域包容性创伤系统，以改善医疗服务的可及性和创伤系统的效率。
