Purtill Mary-Anne, Benedict Kent, Hernandez-Boussard Tina, Brundage Susan I, Kritayakirana Kritaya, Sherck John P, Garland Adella, Spain David A
Department of Surgery, Stanford University, Stanford, California 94305, USA.
J Trauma. 2008 Dec;65(6):1253-7. doi: 10.1097/TA.0b013e31818bbfc2.
Triage of the trauma patient in the field is a complex and challenging issue, especially deciding when to use aeromedical transport. The American College of Surgeons Committee on Trauma recently defined an acceptable under-triage rate [seriously injured patient not taken to a trauma center (TC)] as 5%, whereas over-triage rates may be as high as 25% to 50%. Effective utilization of prehospital helicopter transport requires both accurate assessment of patients and effective communication. The rural county adjacent to our developed trauma system uses standardized triage criteria to identify patients for direct transport to our TCs. We hypothesized these criteria accurately identify major trauma victims (MTV) and further that communication could be simplified to expedite transport.
Prehospital personnel use a MAP (mechanism, anatomy, and physiology) scoring system to triage trauma patients. Patients with > or = 2 "hits" are defined as MTV. In 2004, the triage policy was changed so that MTV would be transported directly to a TC without base hospital consultation (previously required). The Emergency Medical Services (EMS) Medical Director reviewed cases transported to the TC to determine the appropriateness of triage decisions (over- and under-triage using the American College of Surgeons Committee on Trauma definitions). Data were compared before and after this policy change.
For 2004 to 2006, we evaluated 676 air transports to TC and compared them to 468 in the prior 56 months. The overall transport rate increased slightly 7% to 10%. During the study period the over-triage rate was 31% compared with 21%, before the policy change. The MAP triage tool yielded a 93.8% sensitivity and a 99.5% specificity. Therefore, it determined the need for air-medical transport out of a rural environment into an established trauma system with > 90% accuracy.
Prehospital personnel can accurately use a trauma triage tool to identify MTV. Eliminating base station contact, a potential for introducing communication error, did increase over-triage but still well within accepted limits. The system change also resulted in the transport of a greater proportion of minor trauma patients who later proved to have major injuries.
在现场对创伤患者进行分诊是一个复杂且具有挑战性的问题，尤其是决定何时使用空中医疗转运。美国外科医师学会创伤委员会最近将可接受的分诊不足率（重伤患者未被送往创伤中心）定义为5%，而分诊过度率可能高达25%至50%。有效利用院前直升机转运需要对患者进行准确评估并进行有效的沟通。与我们发达的创伤系统相邻的农村县使用标准化分诊标准来确定直接送往我们创伤中心的患者。我们假设这些标准能准确识别主要创伤受害者，并且进一步认为可以简化沟通以加快转运。
院前人员使用MAP（机制、解剖学和生理学）评分系统对创伤患者进行分诊。得分≥2分的患者被定义为主要创伤受害者。2004年，分诊政策发生了变化，主要创伤受害者无需与基地医院协商（以前需要）即可直接转运至创伤中心。紧急医疗服务（EMS）医疗主任审查了送往创伤中心的病例，以确定分诊决策的适当性（使用美国外科医师学会创伤委员会的定义进行分诊过度和不足）。对这一政策变化前后的数据进行了比较。
2004年至2006年，我们评估了676例空中转运至创伤中心的病例，并将其与之前56个月的468例进行了比较。总体转运率略有上升，从7%升至10%。在研究期间，分诊过度率为31%，而政策变化前为21%。MAP分诊工具的敏感性为93.8%，特异性为99.5%。因此，它确定从农村环境转运至已建立的创伤系统进行空中医疗转运的必要性，准确率超过90%。
院前人员可以准确使用创伤分诊工具来识别主要创伤受害者。消除基站联系（这是引入沟通错误的一个潜在因素）确实增加了分诊过度，但仍在可接受范围内。系统的改变还导致了更大比例的轻度创伤患者被转运，而这些患者后来被证明有重伤。
