Center for Policy and Research in Emergency Medicine, Department of Emergency Medicine, Oregon Health and Science University, Portland, Oregon 97239-3098, USA.
J Trauma Acute Care Surg. 2013 May;74(5):1298-306; discussion 1306. doi: 10.1097/TA.0b013e31828b7848.
National benchmarks for trauma triage sensitivity (≥95%) and specificity (≥50%) have not been rigorously evaluated across broad populations of injured patients. We evaluated the impact of different field triage schemes for identifying seriously injured patients across a range of sensitivity values. Impact metrics included specificity and number of undertriaged and overtriaged patients compared with current triage practices.
This was a retrospective cohort study of injured children and adults transported by 48 emergency medical service (EMS) agencies to 105 hospitals in 6 regions of the Western United States from 2006 through 2008. Hospital outcomes were probabilistically linked to EMS records through trauma registries, state discharge databases, and state emergency department databases. The primary outcome was an Injury Severity Score (ISS) of 16 or greater. We evaluated 40 field predictor variables, including 31 current field triage criteria, using classification and regression tree analysis and cross-validation to generate estimates for sensitivity and specificity.
A total of 89,261 injured patients were evaluated and transported by EMS providers during the 3-year period, of whom 5,711 (6.4%) had ISS of 16 or greater. As the 95% sensitivity target for triage was approached (from the current value of 87.5%), decision tree complexity increased, specificity decreased (from 62.8% to 18.7%), and the number of triage-positive patients without serious injury doubled (67,927 vs. 31,104). Analyses restricted to children and older adults were similar. The most consistent modification to the current triage algorithm to increase sensitivity without a major decrease in specificity was altering the Glasgow Coma Scale (GCS) score cutoff point from 13 or less to 14 or less (sensitivity increase to 90.4%).
Reaching the field triage sensitivity benchmark of 95% would require a large decrease in specificity (increase in overtriage). A 90% sensitivity target seems more realistic and may be obtainable by modest changes to the current triage algorithm.
国家创伤分诊的敏感性（≥95%）和特异性（≥50%）基准尚未在广泛的受伤患者人群中得到严格评估。我们评估了不同的现场分诊方案在一系列敏感性值下识别重伤患者的效果。影响指标包括与当前分诊实践相比，分诊不足和分诊过度的患者的特异性和数量。
这是一项回顾性队列研究，涉及 2006 年至 2008 年期间，美国西部 6 个地区的 48 个紧急医疗服务（EMS）机构向 105 家医院转运的受伤儿童和成人。通过创伤登记处、州出院数据库和州急诊数据库，对医院结果进行概率链接到 EMS 记录。主要结局是损伤严重程度评分（ISS）为 16 或更高。我们使用分类和回归树分析和交叉验证评估了 40 个现场预测变量，包括 31 个当前现场分诊标准，以生成敏感性和特异性的估计值。
在 3 年期间，共有 89261 名受伤患者接受了 EMS 提供者的评估和转运，其中 5711 名（6.4%）ISS 为 16 或更高。随着分诊的 95%敏感性目标（从当前的 87.5%）接近，决策树的复杂性增加，特异性降低（从 62.8%降至 18.7%），没有严重损伤的分诊阳性患者数量增加了一倍（67927 比 31104）。对儿童和老年患者的分析结果相似。在不显著降低特异性的情况下提高敏感性的最一致的修改当前分诊算法的方法是将格拉斯哥昏迷评分（GCS）评分从 13 或以下更改为 14 或以下（敏感性提高到 90.4%）。
达到 95%的现场分诊敏感性基准将需要大大降低特异性（过度分诊增加）。90%的敏感性目标似乎更为现实，可以通过对当前分诊算法进行适度的改变来实现。
