评估大学医院创伤小组激活方案。
Evaluation of a university hospital trauma team activation protocol.
机构信息
Department of Gastrointestinal Surgery, University Hospital of North Norway Tromsø, Tromsø, Norway.
出版信息
Scand J Trauma Resusc Emerg Med. 2011 Mar 28;19:18. doi: 10.1186/1757-7241-19-18.
BACKGROUND
Admission with a multidisciplinary trauma team may be vital for the severely injured patient, as this facilitates rapid diagnosis and treatment. On the other hand, patients with minor injuries do not need the trauma team for adequate care. Correct triage is important for optimal resource utilization. The aim of the study was to evaluate our criteria for activating the trauma team, and identify suboptimal criteria that might be changed in the interest of precision.
METHODS
The study is an observational, retrospective cohort-study. All patients admitted with the trauma team (n = 382), all severely injured (Injury Severity Score (ISS) >15) (n = 161), and all undergoing an emergency procedure aimed at counteracting compromised airways, respiration or circulation at our hospital (n = 142) during 2006-2007 were included. Data were recorded from the admission records and the electronic patient records. The trauma team activation protocol was evaluated against the occurrence of severe injury and the occurrence of emergency procedures.
RESULTS
A total of 441 patients were included. The overtriage was 71% and undertriage 32% when evaluating against ISS >15 as the standard of reference. When occurrence of emergency procedures was held as the standard of standard of reference, the over- and undertriage was 71% and 21%, respectively. Mechanism of injury-criteria for trauma team activation contributed the most to overtriage. The emergency procedures performed were mostly endotracheal intubation and external fixation of fractures. Less than 3% needed haemostatic laparotomy or thoracotomy. Approximately 2/3 of the overtriage represented isolated head or cervical spine injuries, and/or interhospital transfers.
CONCLUSIONS
The over- and undertriage of our protocol are both too high. To decrease overtriage we suggest omissions and modifications of some of the criteria. To decrease undertriage, transferred patients and patients with head injuries should be more thoroughly assessed against the trauma team activation criteria.
背景
对于严重受伤的患者，多学科创伤团队的入院可能至关重要，因为这有助于快速诊断和治疗。另一方面，对于轻微受伤的患者，他们不需要创伤团队进行充分的护理。正确的分诊对于最佳资源利用很重要。本研究的目的是评估我们激活创伤团队的标准，并确定可能需要改变的不精确标准。
方法
这是一项观察性、回顾性队列研究。所有因创伤团队入院的患者（n=382）、所有严重受伤的患者（损伤严重程度评分（ISS）>15）（n=161）、以及所有在我们医院接受旨在对抗气道、呼吸或循环受损的紧急手术的患者（n=142）都包括在内。数据来自入院记录和电子病历。评估创伤团队激活方案是否符合严重损伤的发生和紧急手术的发生。
结果
共纳入 441 例患者。当 ISS>15 作为参考标准时，过度分诊率为 71%，分诊不足率为 32%。当以紧急手术的发生作为参考标准时，过度分诊率和分诊不足率分别为 71%和 21%。创伤团队激活机制的损伤机制标准导致过度分诊最多。实施的紧急手术主要是气管插管和骨折的外固定。不到 3%的患者需要止血剖腹术或开胸术。大约 2/3的过度分诊代表孤立的头部或颈椎损伤，和/或院内转科。
结论
我们的方案中过度分诊和分诊不足的比例都过高。为了减少过度分诊，我们建议对一些标准进行省略和修改。为了减少分诊不足，应更彻底地评估转科患者和头部受伤患者是否符合创伤团队激活标准。
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