Keenan Research Centre, Li Ka Shing Knowledge Institute, St Michael's Hospital, Division of General Surgery, Department of Surgery, University of Toronto, Toronto, Ontario, Canada.
Prehosp Emerg Care. 2012 Oct-Dec;16(4):456-62. doi: 10.3109/10903127.2012.695431. Epub 2012 Jun 27.
Urban trauma systems are characterized by high population density, availability of trauma centers, and acceptable road transport times (within 30 minutes). In such systems, patients meeting field trauma triage (FTT) criteria should be transported directly to a trauma center, bypassing closer non-trauma centers.
We evaluated emergency medical services (EMS) triage practices to identify opportunities for improving care delivery.
Specifically, we evaluated the effect of the additional distance to a trauma center, compared with a closer non-trauma center, on the noncompliance with trauma destination criteria by EMS personnel in an urban environment.
This was a retrospective cohort study of adults having at least one physiologic derangement and meeting Toronto EMS field trauma triage criteria from 2005 to 2010. Road travel distances between the site of injury, the closest non-trauma center, and the closest trauma center were estimated using geographic information systems. For patients who were transported to non-trauma centers, we estimated "differential distance": the additional travel distance required to transport directly to a trauma center. Logistic regression was used to analyze the effect of differential distance on triage decisions, adjusting for other patient characteristics.
Inclusion criteria identified 898 patients; 53% were transported directly to a trauma center. Falls, female gender, and age greater than 65 years were associated with transport to non-trauma centers. Differential distances greater than 1 mile were associated with a decreased likelihood of triage to a trauma center.
Differential distance between the closest non-trauma center and the closest trauma center was associated with lower compliance with triage protocols, even in an urban setting where trauma centers can be accessed within approximately 30 minutes. Our findings suggest that there are opportunities for reducing the gap between ideal and actual application of field trauma triage guidelines through a process of education and feedback.
城市创伤系统的特点是人口密度高、创伤中心可用性高，以及可接受的道路转运时间（30 分钟内）。在这样的系统中，符合现场创伤分诊（FTT）标准的患者应直接转运至创伤中心，绕过较近的非创伤中心。
我们评估了紧急医疗服务（EMS）分诊实践，以确定改善护理提供的机会。
具体来说，我们评估了与较近的非创伤中心相比，到创伤中心的额外距离对 EMS 人员在城市环境中不符合创伤目的地标准的影响。
这是一项回顾性队列研究，纳入了 2005 年至 2010 年期间至少有一项生理紊乱且符合多伦多 EMS 现场创伤分诊标准的成年人患者。使用地理信息系统估计损伤部位与最近的非创伤中心和最近的创伤中心之间的道路行驶距离。对于转运至非创伤中心的患者，我们估计了“差异距离”：直接转运至创伤中心所需的额外转运距离。使用逻辑回归分析差异距离对分诊决策的影响，同时调整了其他患者特征。
纳入标准确定了 898 例患者；53%的患者被直接转运至创伤中心。坠落伤、女性和年龄大于 65 岁与转运至非创伤中心相关。差异距离大于 1 英里与更不可能分诊至创伤中心相关。
即使在创伤中心可在大约 30 分钟内到达的城市环境中，最近的非创伤中心与最近的创伤中心之间的差异距离与较低的分诊协议遵守率相关。我们的研究结果表明，通过教育和反馈的过程，有可能缩小现场创伤分诊指南的理想与实际应用之间的差距。
