验证用于机动车事故的创伤分诊标准。
Validation of prehospital trauma triage criteria for motor vehicle collisions.
机构信息
From the Harborview Injury Prevention and Research Center (G.H.D., F.P.R., C.D.M., R.K., E.M.B.), and the Departments of Surgery (G.H.D., E.M.B.), Pediatrics (F.P.R.), and Epidemiology (F.P.R.), University of Washington, Harborview Medical Center, Seattle, Washington; and Department of Surgery (G.J.J.), University of Colorado School of Medicine, Denver Health and Hospitals Authority, Aurora, Colorado.
出版信息
J Trauma Acute Care Surg. 2014 Mar;76(3):755-61. doi: 10.1097/TA.0000000000000091.
BACKGROUND
Triage of an injured patient to an appropriate trauma center can have an impact on morbidity and mortality. We sought to validate the 2012 national field triage guidelines for motor vehicle crashes.
METHODS
This is a retrospective cross-sectional study using the National Automotive Sampling System Crashworthiness Data System. Vehicle damage criteria proposed as prehospital triage guidelines were correlated with injury severity.
RESULTS
There were 85,761 individuals representing 29,397,234 occupants in car crashes from 2003 to 2008. Of the patients, 3.8% met physiologic Step 1 criteria with a mean Injury Severity Score (ISS) of 9.1 (95% confidence interval [CI], -3.1 to 20.9); Step 1 had a positive predictive value (PPV) of 20.8% (95% CI, 20.1-21.4%) for severe injury (ISS > 15). Of the patients, 0.43% met anatomic Step 2 criteria alone, with a mean ISS of 18.1 (95% CI, 16.4-19.8) and a PPV of 48.5% (95% CI, 46.8-50.1%). Step 3 criteria include injury mechanism; 3.7% of the patients met one of these criteria alone with a mean ISS of 5.1 (95% CI, 4.4-5.8) and a PPV of 9.7% (95% CI, 9.3-10.2%).Patients who met only Step 3 criteria were examined to determine crash characteristics that predict severe injury. Intrusion of greater than 12 inches had a PPV of 10.4% (95% CI, 9.5-11.3); steering wheel collapse had a PPV of 25.7% (95% CI, 23.0-28.4%). Older patients (age > 55 years) who met Step 3 mechanism criteria had higher predictive values for injury for nearly all crash characteristics.
CONCLUSION
Injury mechanism criteria alone predict significant injury in a substantial proportion of patients who did not meet the physiologic or anatomic criteria. Vehicular crash data could improve the ability of emergency medical service providers to triage injured occupants. Consideration of transport to a trauma center should be given for elderly patients and drivers with steering wheel collapse.
LEVEL OF EVIDENCE
Epidemiologic study, level III.
背景
对受伤患者进行适当的创伤中心分诊可能会对发病率和死亡率产生影响。我们试图验证 2012 年国家现场分诊指南用于机动车碰撞。
方法
这是一项使用国家汽车抽样系统碰撞安全性数据系统的回顾性横断面研究。提出了车辆损伤标准作为院前分诊指南，并与损伤严重程度相关联。
结果
2003 年至 2008 年期间，共有 85761 人代表 29397234 名乘客发生汽车碰撞。其中 3.8%符合生理第 1 步标准，平均损伤严重程度评分（ISS）为 9.1（95%置信区间 [CI]，-3.1 至 20.9）；第 1 步的严重损伤阳性预测值（PPV）为 20.8%（95%CI，20.1-21.4%）（ISS > 15）。单独符合解剖第 2 步标准的患者占 0.43%，平均 ISS 为 18.1（95%CI，16.4-19.8），PPV 为 48.5%（95%CI，46.8-50.1%）。第 3 步标准包括损伤机制；单独符合这些标准之一的患者占 3.7%，平均 ISS 为 5.1（95%CI，4.4-5.8），PPV 为 9.7%（95%CI，9.3-10.2%）。仅符合第 3 步标准的患者进行了检查，以确定预测严重损伤的碰撞特征。侵入大于 12 英寸的患者 PPV 为 10.4%（95%CI，9.5-11.3%）；转向盘塌陷的患者 PPV 为 25.7%（95%CI，23.0-28.4%）。符合第 3 步机制标准的年龄较大（>55 岁）的患者对几乎所有碰撞特征的损伤预测值更高。
结论
单独的损伤机制标准可预测未符合生理或解剖标准的患者中有相当比例的患者发生严重损伤。车辆碰撞数据可以提高紧急医疗服务提供者对受伤乘客进行分诊的能力。对于老年患者和转向盘塌陷的驾驶员，应考虑将其送往创伤中心。
证据水平
流行病学研究，III 级。
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