2005 年至 2009 年加利福尼亚州分诊的变异性：一项基于人群的严重受伤患者纵向研究。
Variability in California triage from 2005 to 2009: a population-based longitudinal study of severely injured patients.
机构信息
From the Department of Surgery (K.S., D.S.), Stanford University School of Medicine, Stanford; and Departments of Epidemiology and Biostatistics (F.L.), Surgery (R.M.), Emergency Medicine (R.H.), University of California, San Francisco, California.
出版信息
J Trauma Acute Care Surg. 2014 Apr;76(4):1041-7. doi: 10.1097/TA.0000000000000197.
BACKGROUND
Timely access to trauma care requires that severely injured patients are ultimately triaged to trauma centers. We sought to determine triage patterns for the injured population within the state of California to determine those factors associated with undertriage.
METHODS
We conducted a retrospective analysis of all hospital visits in California using the Office of Statewide Health Planning and Development Database from January 1, 2005, and December 31, 2009. All visits associated with injury were linked longitudinally. Sixty-day and one-year mortality was determined using vital statistics data. Primary field triage was defined as field triage to a Level I/II trauma center; retriage was defined as initial triage to a non-Level I/II center followed by transfer to a Level I/II. Regions were organized by local emergency medical services agencies. The primary outcomes were triage patterns and mortality.
RESULTS
The undertriage rate was 35% (n = 20,988) but was variable across regions (12-87%). Primary field triage ranged from 7% to 77%. Retriage rates not only were overall low (6% of all severely injured patients) but also varied by region (1-38%). In adjusted analysis, factors associated with a lower odds ratio (OR) of primary field triage included the following: age of 55 years or greater (OR, 0.78; p = 0.001), female sex (OR, 0.88; p = 0.014), greater number of comorbidities (OR, 0.92; p < 0.001), and fall mechanism versus motor vehicle collision (OR, 0.54; p < 0.001). One-year mortality was higher for undertriaged patients (25% vs. 16% and 18% for primary field and retriage, respectively, p < 0.001).
CONCLUSION
This is the first study to create a longitudinal database of all emergency department visits, hospitalizations, and long-term mortality for every severely injured patient within an entire state during a 5-year period. Undertriage varied substantially by region and was associated with multiple factors including access to care and patient factors.
LEVEL OF EVIDENCE
Epidemiologic study, level III.
背景
及时获得创伤护理需要将严重受伤的患者最终分诊到创伤中心。我们旨在确定加利福尼亚州受伤人群的分诊模式，以确定与分诊不足相关的因素。
方法
我们使用加利福尼亚州卫生规划和发展办公室数据库，对 2005 年 1 月 1 日至 2009 年 12 月 31 日期间的所有医院就诊进行了回顾性分析。所有与损伤相关的就诊均进行纵向关联。使用人口统计数据确定 60 天和 1 年死亡率。初步现场分诊定义为现场分诊至一级/二级创伤中心；重新分诊定义为最初分诊至非一级/二级中心，然后转至一级/二级中心。区域由当地紧急医疗服务机构组织。主要结局是分诊模式和死亡率。
结果
分诊不足率为 35%（n=20988），但各区域之间存在差异（12%-87%）。初步现场分诊范围从 7%到 77%。重新分诊率不仅总体较低（所有严重受伤患者的 6%），而且各区域之间也存在差异（1%-38%）。在调整后的分析中，与初级现场分诊可能性较低相关的因素包括以下因素：年龄 55 岁或以上（OR，0.78；p=0.001）、女性（OR，0.88；p=0.014）、合并症较多（OR，0.92；p<0.001）和坠落机制与机动车碰撞（OR，0.54；p<0.001）。分诊不足的患者一年死亡率更高（25%比初级现场和重新分诊的 16%和 18%，p<0.001）。
结论
这是第一项在 5 年内创建整个州内每个严重受伤患者的急诊就诊、住院和长期死亡率的纵向数据库的研究。分诊不足在各区域之间存在显著差异，与包括获得医疗服务和患者因素在内的多个因素相关。
证据水平
流行病学研究，三级。
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