Bevan Catherine, Officer Clara, Crameri Joe, Palmer Cameron, Babl Franz E
Trauma Service and Emergency Department, Royal Children's Hospital and University of Melbourne, Melbourne, Australia.
J Trauma. 2009 Mar;66(3):698-702. doi: 10.1097/TA.0b013e318165b2f7.
To improve utilization of scarce surgical resources, we changed from a single tier trauma paging system (TPS) to a three tiered TPS at a tertiary pediatric trauma center. We investigated if patients were appropriately classified into the three levels of trauma team activation.
Trauma registry data were used to review data 12 months before and after implementation of a three tiered TPS (level I entire team present, level II surgical subspecialties within 10 minutes, level III emergency department team only at patient arrival). We correlated TPS activation with proxies of injury severity (admission status and major/nonmajor trauma).
There were 192 activations during 12 months of the single tier TPS and 216 during the three tier TPS (33 level I, 49 level II, and 134 level III). The entire team was to attend in all 192 single tier and in 82 (40%) level I and II three tier TPS activations i.e., there were 60% fewer surgical team activations. During single tier TPS, 96% patients were admitted and 23% classified as major trauma. Three tiered TPS level I, II and III were admitted in 97%, 94%, and 81% and classified as major trauma in 58%, 35%, and 15%, respectively. Of the 20 level III patients classified as major trauma, TPS level was deemed appropriate in 18 and inappropriately low in 2, although patient care had not been compromised.
Our results suggest that a three tiered TPS more efficiently utilizes limited surgical resources without leading to major misclassifications.
为提高稀缺手术资源的利用率，我们在一家三级儿科创伤中心将单层创伤传呼系统（TPS）改为三层TPS。我们调查了患者是否被正确分类到创伤团队激活的三个级别。
使用创伤登记数据回顾三层TPS实施前后12个月的数据（一级全体团队到场，二级手术亚专科在10分钟内到场，三级仅急诊科团队在患者到达时到场）。我们将TPS激活与损伤严重程度的指标（入院状态和重伤/非重伤）相关联。
单层TPS的12个月中有192次激活，三层TPS中有216次激活（33次一级、49次二级和134次三级）。全体团队应参加所有192次单层以及82次（40%）一级和二级三层TPS激活，即手术团队激活次数减少了60%。在单层TPS期间，96%的患者入院，23%被分类为重伤。三层TPS的一级、二级和三级患者入院率分别为97%、94%和81%，被分类为重伤的比例分别为58%、35%和15%。在20例被分类为重伤的三级患者中，18例的TPS级别被认为合适，2例被认为过低，尽管患者护理未受影响。
我们的结果表明，三层TPS更有效地利用了有限的手术资源，且不会导致重大的错误分类。
