Kleber Christian, Cwojdzinski Detlef, Strehl Markus, Poloczek Stefan, Haas Norbert P
Charité - Universitätsmedizin Berlin, Berlin, Germany.
Am J Disaster Med. 2013 Winter;8(1):5-11. doi: 10.5055/ajdm.2013.0106.
In-hospital triage is the key factor for successful management of an overwhelming number of patients in lack of treatment capacity. The main goal of in-hospital triage is to identify casualties with life-threatening injuries and to allocate immediate medical aid. For the first time, we evaluate the quality of in-hospital triage in the German capital Berlin.
In this prospective observational study of 17 unheralded external mass casualty trainings for Berlin disaster hospitals in 2010/2011, we analyzed the in-hospital triage of 601 rouged casualty actors. Evaluation was performed by structured external survey and interview of the casualty actors after the disaster training. In 93 percent (n = 558), complete data were available and suitable for statistical analysis.
The primary triage category was allocated correctly to 61 percent (n = 338) of the simulated injury severity. The following measurements were performed: anamnesis in 77 percent, physical examination 71 percent, blood pressure in 68 percent, heart rate in 61 percent, and oxygen saturation in 25 percent. Additive radiological diagnostics were used: 38 percent X-ray, 16 percent computer tomography, and 7 percent ultrasound. On an average, 1.6 ± 1.2 diagnostic tools were used to allocate injury severity to rouged casualties. Of all the rouged casualties, 24 percent overtriage and 16 percent undertriage were observed. Overtriage was significantly infrequent in level I trauma centers (p = 0.03). Of the patients with life-threatening injuries, 18 percent was undertriaged. Of the 62 percent with secondary right allocation to triage category, re-triage was only used in 4 percent.
The accuracy of in-hospital triage is low (61 percent). Predominately, the problem of overtriage (24 percent) due to insufficient triage training in contrast to undertriage (16 percent) occurs. The diagnostic triage adjuncts, ultrasound and re-triage, should be routinely used to lower the rate of undetected life threat in mass casualty incidents. Furthermore, a standardized training program and triage algorithm for in-hospital triage should be established.
在治疗能力不足的情况下，院内分诊是成功管理大量患者的关键因素。院内分诊的主要目标是识别有危及生命损伤的伤员并给予即时医疗救助。我们首次对德国首都柏林的院内分诊质量进行评估。
在这项针对2010/2011年柏林灾难医院17次非预告性外部大规模伤亡培训的前瞻性观察研究中，我们分析了601名模拟伤亡者的院内分诊情况。评估通过灾难培训后对伤亡者进行结构化外部调查和访谈来进行。93%（n = 558）的案例有完整数据且适合进行统计分析。
主要分诊类别被正确分配到61%（n = 338）的模拟损伤严重程度案例中。进行了以下检查：77%进行了问诊，71%进行了体格检查，68%测量了血压，61%测量了心率，25%测量了血氧饱和度。还使用了辅助放射诊断：38%进行了X光检查，16%进行了计算机断层扫描，7%进行了超声检查。平均而言，使用1.6 ± 1.2种诊断工具来确定模拟伤亡者的损伤严重程度。在所有模拟伤亡者中，观察到24%过度分诊和16%分诊不足。一级创伤中心的过度分诊明显较少（p = 0.03）。有危及生命损伤的患者中，18%被分诊不足。在62%随后被正确重新分配分诊类别的患者中，只有4%进行了重新分诊。
院内分诊的准确性较低（61%）。主要问题是与分诊不足（16%）相比，由于分诊培训不足导致过度分诊（24%）的情况出现。诊断性分诊辅助手段，如超声和重新分诊，应常规使用以降低大规模伤亡事件中未被发现的生命威胁发生率。此外，应建立标准化的院内分诊培训计划和分诊算法。
