瑞士直升机紧急医疗服务院前诊断和分诊的准确性。
Accuracy of prehospital diagnosis and triage of a Swiss helicopter emergency medical service.
机构信息
Departments of Anesthesiology and Pain Therapy, University Hospital Bern, Bern, Switzerland.
出版信息
J Trauma Acute Care Surg. 2012 Sep;73(3):709-15. doi: 10.1097/TA.0b013e31825c14b7.
BACKGROUND
Helicopter emergency medical services (HEMSs) have become a standard element of modern prehospital emergency medicine. This study determines the percentage of injured HEMS patients whose injuries were correctly recognized by HEMS physicians.
METHODS
A retrospective level III evidence prognostic study using data from the largest Swiss HEMS, REGA (Rettungsflugwacht/Guarde Aérienne), on adult patients with trauma transported to a Level I trauma center (January 2006-December 2007). National Advisory Committee on Aeronautics (NACA) scores and the Injury Severity Score (ISS) were assessed to identify severely injured patients. Injured body regions diagnosed by REGA physicians were compared with emergency department discharge diagnoses.
RESULTS
Four hundred thirty-three patients were analyzed. Median age was 42.1 years (interquartile range, 25.5-57.9). Three hundred twenty-three (74.6%) were men. Patients were severely injured, with an in-hospital NACA score of 4 or higher in 88.7% of patients and median ISS of 13. REGA physicians correctly recognized injuries to the head in 92.9%, to the femur in 90.5%, and to the tibia/fibula in 83.8% of patients. Injuries to these body regions were overdiagnosed in less than 30%. Abdominal injuries were missed in 56.1%, pelvic injuries in 51.8%, spinal injuries in 40.1%, and chest injuries in 31.2% of patients.
CONCLUSION
This study shows that patients are adequately triaged by REGA physicians reflected by a NACA score 4 or higher in 88.7% of patients and a median ISS of 13. However, recognition of injured body regions seems to be challenging in the prehospital setting. Prospective studies on specific training of HEMS physicians for recognition of these injuries (e.g., portable ultrasonography, telemedicine) might help in the future.
LEVEL OF EVIDENCE
Prognostic study, level III.
背景
直升机紧急医疗服务（HEMS）已成为现代院前急救医学的标准要素。本研究旨在确定 HEMS 医师正确识别 HEMS 受伤患者的比例。
方法
这是一项使用瑞士最大的 HEMS（REGA）的数据进行的回顾性三级证据预后研究，纳入 2006 年 1 月至 2007 年 12 月期间转运至一级创伤中心的成年创伤患者。使用国家航空咨询委员会（NACA）评分和损伤严重程度评分（ISS）来识别重伤患者。比较 REGA 医师诊断的受伤部位与急诊出院诊断。
结果
共分析了 433 例患者。中位年龄为 42.1 岁（四分位间距 25.5-57.9）。323 例（74.6%）为男性。患者伤势严重，88.7%的患者住院时 NACA 评分≥4，ISS 中位数为 13。REGA 医师对头、股骨和胫骨/腓骨的损伤识别正确，准确率分别为 92.9%、90.5%和 83.8%。这些部位的损伤漏诊率低于 30%。腹部损伤漏诊率为 56.1%，骨盆损伤漏诊率为 51.8%，脊柱损伤漏诊率为 40.1%，胸部损伤漏诊率为 31.2%。
结论
本研究表明，REGA 医师通过对 88.7%的患者进行 NACA 评分≥4 和 ISS 中位数为 13 来进行充分的分诊。然而，在院前环境中识别受伤部位似乎具有挑战性。未来可能需要对 HEMS 医师进行特定的识别这些损伤的培训（例如，便携式超声、远程医疗）进行前瞻性研究。
证据等级
预后研究，III 级。
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