Department of Emergency Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin, USA.
Prehosp Emerg Care. 2011 Jan-Mar;15(1):12-7. doi: 10.3109/10903127.2010.519819. Epub 2010 Nov 5.
In 2006, the Centers for Disease Control and Prevention (CDC) released a revised Field Triage Decision Scheme. It is unknown how this modified scheme will affect the number of patients identified by emergency medical services (EMS) for transport to a trauma center.
To determine the change in the number of patients transported by EMS who meet the 2006 scheme, compared with the 1999 scheme, and to determine how the scheme change would affect under- and overtriage rates.
The EMS providers in charge of care for injured adult patients transported to a regional trauma center in three mid-sized cities were interviewed immediately after completing transport. All injured patients were included, regardless of severity. The interview included patient demographics, vital signs, apparent anatomic injury, and the mechanism of injury. Included patients were then followed through hospital discharge. The 1999 and 2006 scheme criteria were each retrospectively applied to the collected data. The numbers of patients identified by the two schemes were determined. Patients were considered to have needed a trauma center if they had nonorthopedic surgery within 24 hours, were admitted to an intensive care unit (ICU), or died. Data were analyzed using descriptive statistics including 95% confidence intervals.
EMS interviews were conducted for 11,892 patients and outcome data were unavailable for one patient. The average patient age was 48 years; 51% of the patients were men. Providers reported bringing 54% of the enrolled patients to the trauma center based on their local trauma protocol. Medical record review identified 12% of the enrolled patients as needing a trauma center. Use of the 2006 scheme would have resulted in 1,423 fewer patients (12%; 95% confidence interval [CI]:11%-13%) being identified as needing a trauma center by EMS providers (40%; 95% CI: 39%-41% versus 28%; 95% CI: 27%-29%). Of those patients, 1,344 (94%) did not actually need the resources of a trauma center, whereas 78 (6%) actually needed the resources of a trauma center and would have been undertriaged.
Use of the 2006 Field Triage Decision Scheme would have resulted in a significant decrease in the number of patients identified as needing the resources of a trauma center. These changes reduced overtriage while causing a small increase in the number of patients who would have been undertriaged.
2006 年，疾病控制与预防中心（CDC）发布了修订后的现场分诊决策方案。目前尚不清楚该修改后的方案将如何影响紧急医疗服务（EMS）确定送往创伤中心的患者人数。
确定与 1999 年方案相比，按 2006 年方案确定的由 EMS 转运的患者人数变化，并确定方案变化如何影响分诊不足和过度的比例。
在三个中等城市的区域创伤中心接受治疗的成年受伤患者的 EMS 提供者在完成转运后立即接受采访。所有受伤患者均包括在内，无论严重程度如何。访谈包括患者的人口统计学特征、生命体征、明显的解剖损伤和损伤机制。随后对所有患者进行了医院出院随访。分别对收集的数据应用 1999 年和 2006 年的方案标准。确定两种方案确定的患者人数。如果患者在 24 小时内接受非骨科手术、入住重症监护病房（ICU）或死亡，则认为患者需要创伤中心。使用包括 95%置信区间的描述性统计数据分析数据。
对 11892 名患者进行了 EMS 访谈，其中一名患者的结果数据无法获得。患者的平均年龄为 48 岁；51%的患者为男性。根据当地的创伤协议，提供者报告说将 54%的入组患者送往创伤中心。病历回顾确定了 12%的入组患者需要创伤中心。如果使用 2006 年方案，EMS 提供者将确定 1423 名（12%；95%置信区间[CI]：11%-13%）需要创伤中心的患者较少（40%；95%CI：39%-41%与 28%；95%CI：27%-29%）。其中，1344 名（94%）患者实际上并不需要创伤中心的资源，而 78 名（6%）患者实际上需要创伤中心的资源，而分诊不足。
使用 2006 年现场分诊决策方案将导致需要创伤中心资源的患者数量显著减少。这些变化减少了分诊过度，同时略微增加了分诊不足的患者数量。
