Claridge Jeffrey A, Golob Joseph F, Leukhardt William H, Kan Justin A, Como John J, Malangoni Mark A, Yowler Charles J
Case Western Reserve University School of Medicine, MetroHealth Medical Center, Cleveland, Ohio 44109-1998, USA.
Am Surg. 2010 Dec;76(12):1401-7.
A two phase prospective study was carried out at a regional Level I trauma center over 1 year. Phase I involved collecting observational data to determine which trauma criteria could potentially be used to identify patients that could be evaluated by a lower level trauma activation (category-3). A category-3 involved a smaller response team with priority access to imaging. Phase II involved implementing this third tier activation system and prospectively evaluating the outcomes related to resources and patient care. A total of 3104 patients were evaluated with 2076 patients in phase I and 1037 in phase II. Three commonly identified activation criteria out of the 36 studied were not associated with admission. These criteria were pedestrian struck by vehicle, high speed vehicular crash, and Glasgow Coma Score 12-14. These criteria were then used as triggers for a category-3 activation in phase II. Comparisons of patients with these three identified criteria between phase I and II demonstrated that significantly fewer patients were admitted, charges were reduced, emergency department times were similar, and less man-power hours were needed in phase II. The utilization of a third tiered activation system resulted in a decrease utilization of many resources without sacrificing patient care.
在一家地区一级创伤中心进行了一项为期1年的两阶段前瞻性研究。第一阶段包括收集观察数据，以确定哪些创伤标准可用于识别可通过较低级别创伤激活（3类）进行评估的患者。3类涉及一个规模较小的反应小组，可优先进行影像学检查。第二阶段包括实施这一第三级激活系统，并前瞻性评估与资源和患者护理相关的结果。共有3104例患者接受评估，其中第一阶段2076例，第二阶段1037例。在研究的36项标准中，有3项常见的确定激活标准与入院无关。这些标准是行人被车辆撞击、高速车辆碰撞和格拉斯哥昏迷评分12 - 14分。这些标准随后在第二阶段用作3类激活的触发因素。对第一阶段和第二阶段具有这三项确定标准的患者进行比较表明，第二阶段入院患者明显减少，费用降低，急诊科停留时间相似，所需人力小时数减少。使用第三级激活系统导致许多资源的利用率降低，同时不影响患者护理。
