Center for Policy and Research in Emergency Medicine, Department of Emergency Medicine, Oregon Health & Science University, Portland, USA.
Ann Emerg Med. 2012 Sep;60(3):335-45. doi: 10.1016/j.annemergmed.2012.04.006. Epub 2012 May 24.
We evaluate trauma undertriage by age group, the association between age and serious injury after accounting for other field triage criteria and confounders, and the potential effect of a mandatory age triage criterion for field triage.
This was a retrospective cohort study of injured children and adults transported by 48 emergency medical services (EMS) agencies to 105 hospitals in 6 regions of the western United States from 2006 through 2008. We used probabilistic linkage to match EMS records to hospital records, including trauma registries, state discharge databases, and emergency department databases. The primary outcome measure was serious injury, as measured by an Injury Severity Score greater than or equal to 16. We assessed undertriage (Injury Severity Score ≥16 and triage-negative or transport to a nontrauma center) by age decile and used multivariable logistic regression models to estimate the association (linear and nonlinear) between age and Injury Severity Score greater than or equal to 16, adjusted for important confounders. We also evaluated the potential influence of age on triage efficiency and trauma center volume.
Injured patients (260,027) were evaluated and transported by EMS during the 3-year study period. Undertriage increased for patients older than 60 years, reaching approximately 60% for those older than 90 years. There was a strong nonlinear association between age and Injury Severity Score greater than or equal to 16. For patients not meeting other triage criteria, the probability of serious injury was most notable after 60 years. A mandatory age triage criterion would have decreased undertriage at the expense of overtriage, with 1 patient with Injury Severity Score greater than or equal to 16 identified for every 60 to 65 additional patients transported to major trauma centers.
Trauma undertriage increases in patients older than 60 years. Although the probability of serious injury increases among triage-negative patients with increasing age, the use of a mandatory age triage criterion appears inefficient for improving field triage.
我们评估了按年龄组划分的创伤性分诊不足的情况，考虑到其他现场分诊标准和混杂因素后，年龄与严重损伤之间的关联，以及对现场分诊实施强制性年龄分诊标准的潜在影响。
这是一项回顾性队列研究，研究对象为 2006 年至 2008 年间，美国西部 6 个地区的 48 家急救医疗服务（EMS）机构送往 105 家医院的受伤儿童和成人。我们使用概率链接将 EMS 记录与医院记录相匹配，包括创伤登记处、州出院数据库和急诊部数据库。主要结局测量指标为严重损伤，以损伤严重程度评分（ISS）大于或等于 16 来衡量。我们根据年龄十分位数评估分诊不足（ISS 大于或等于 16，分诊结果为阴性或送往非创伤中心），并使用多变量逻辑回归模型估计年龄与 ISS 大于或等于 16 之间的关联（线性和非线性），同时调整了重要混杂因素。我们还评估了年龄对分诊效率和创伤中心容量的潜在影响。
在 3 年的研究期间，共评估并由 EMS 运送了 260027 名受伤患者。年龄大于 60 岁的患者分诊不足的比例增加，年龄大于 90 岁的患者达到约 60%。年龄与 ISS 大于或等于 16 之间存在很强的非线性关联。对于不符合其他分诊标准的患者，60 岁以后严重损伤的可能性最为显著。实施强制性年龄分诊标准将以过度分诊为代价减少分诊不足，每有 60 至 65 名患者被送往主要创伤中心，就会漏诊 1 名 ISS 大于或等于 16 的患者。
年龄大于 60 岁的患者中，创伤性分诊不足的情况增加。尽管随着分诊阴性患者年龄的增加，严重损伤的可能性增加，但使用强制性年龄分诊标准似乎并不能有效改善现场分诊。
