Helm M, Faul M, Unger T, Lampl L
Klinik für Anästhesiologie & Intensivmedizin - Sektion Notfallmedizin/Luftrettungszentrum "Christoph 22", Bundeswehrkrankenhaus Ulm, Oberer Eselsberg 40, 89081, Ulm, Deutschland,
Anaesthesist. 2013 Dec;62(12):973-80. doi: 10.1007/s00101-013-2255-x. Epub 2013 Nov 8.
Trauma is the leading cause of death in the patient group under 40 years of age. Within the prehospital management of seriously injured trauma victims the accuracy of the field triage by emergency physicians is of utmost importance.
The aim of this study was to determine the accuracy of prehospital emergency physician field triage in road traffic accident victims.
The study involved a retrospective analysis and comparison of prehospital and inhospital trauma records of road traffic accident victims treated by a Helicopter Emergency Medical Service (HEMS) team and transferred to a level I trauma centre. A comparison of prehospital and inhospital diagnostic findings was carried out according to an anatomical score (AIS).
Included in the analysis were 479 patients with a mean age of 37.0 ± 18.2 years, males 65.8 %, mean injury severity score (ISS) 15.5 ± 13.5, ISS > 16 in 41,1 % and mortality 7.3 %. The leading causes of injury were motor vehicle accidents (56.2 %), followed by motorcycle (24.0 %) and bicycle accidents (11.6 %) as well as truck accidents (4.0 %) and pedestrian accidents (4.2 %). The most common body regions injured (AIS ≥ 3) were the chest (37 %), head (25.1 %) and lower extremities (16.7 %). A correct prehospital field triage by emergency physicians was found for injuries with an AIS ≥ 3 of the head 77 %, chest 69 %, abdomen 51 %, pelvis 49 %, extremities 70 %, neck/cervical spine 67 % and thoracic/lumbar spine 70 %. Overlooked injuries in the prehospital setting (AIS ≥ 3) comprised predominantly injuries of the trunk (chest 12.6 %, abdomen 16.9 % and pelvis 15 %). Overlooked injuries were found significantly less for the head in patients with a Glasgow Coma Score ≤ 8 on arrival at the scene (5.4 % versus 19 %, p = 0.015), for the chest in patients with a S(p)O(2) ≤ 96 % on arrival at the scene (18.1 % versus 35.5 %, p = 0.004) and for the abdomen in patients with a systolic blood pressure < 90 mmHg on arrival at the scene (28.6 % versus 52.5 %, p = 0.025).
Accurate field triage in seriously injured road accident victims, even by trained physicians, is difficult. This pertains especially to injuries to the abdomen and the pelvis. For the field triage a combination of anatomical and physiological criteria as well as the mechanism of injury should be used to increase accuracy.
创伤是40岁以下患者群体的主要死因。在重伤创伤受害者的院前管理中，急诊医生进行现场分诊的准确性至关重要。
本研究旨在确定院前急诊医生对道路交通事故受害者进行现场分诊的准确性。
本研究对直升机紧急医疗服务（HEMS）团队救治并转至一级创伤中心的道路交通事故受害者的院前和院内创伤记录进行回顾性分析和比较。根据解剖学评分（AIS）对院前和院内诊断结果进行比较。
纳入分析的患者有479例，平均年龄37.0±18.2岁，男性占65.8%，平均损伤严重程度评分（ISS）为15.5±13.5，ISS>16的患者占41.1%，死亡率为7.3%。受伤的主要原因是机动车事故（56.2%），其次是摩托车事故（24.0%）、自行车事故（11.6%）、卡车事故（4.0%）和行人事故（4.2%）。受伤最常见的身体部位（AIS≥3）是胸部（37%）、头部（25.1%）和下肢（16.7%）。急诊医生对头部AIS≥3的损伤进行正确院前现场分诊的比例为77%，胸部为69%，腹部为51%，骨盆为49%，四肢为70%，颈部/颈椎为67%，胸腰椎为70%。院前漏诊的损伤（AIS≥3）主要是躯干损伤（胸部12.6%、腹部16.9%和骨盆15%）。到达现场时格拉斯哥昏迷评分≤8分的患者头部漏诊损伤明显较少（5.4%对19%，p=0.015），到达现场时血氧饱和度（S(p)O(2)）≤96%的患者胸部漏诊损伤明显较少（18.1%对35.5%，p=0.004），到达现场时收缩压<90 mmHg的患者腹部漏诊损伤明显较少（28.6%对52.5%，p=0.025）。
即使是训练有素的医生，对重伤道路事故受害者进行准确的现场分诊也很困难。这尤其适用于腹部和骨盆损伤。对于现场分诊，应结合解剖学和生理学标准以及损伤机制来提高准确性。
