医生和院前急救人员对机动车碰撞严重程度的评估。

Motor vehicle crash severity estimations by physicians and prehospital personnel.

作者信息

Cleveland Nathan, Colwell Christopher, Douglass Erica, Hopkins Emily, Haukoos Jason S

出版信息

Prehosp Emerg Care. 2014 Jul-Sep;18(3):402-7. doi: 10.3109/10903127.2014.891065. Epub 2014 Mar 26.

DOI:10.3109/10903127.2014.891065

PMID:24670008

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC4915374/

Abstract

OBJECTIVE

To determine whether emergency physicians (EPs) and prehospital emergency medical services (EMS) personnel differ in their assessment of motor vehicle crash (MVC) severity and the potential for serious injury when viewing crash scene photographs.

METHODS

Attending and resident EPs, paramedics, and emergency medical technicians (EMTs) from a single emergency medicine system used a web-based survey platform to rate the severity of 100 crash photographs on a 10-point Likert scale (Crash Score) and the potential for serious injury on a 0-100% scale (Injury Score). Serious injury was defined as skull fracture or intracranial bleeding, spine fracture or spinal cord injury, intrathoracic or intraabdominal injury, or long bone fracture. Crash and Injury Scores were stratified into EP and paramedic/EMT (EMS) groups and the mean score was calculated for each photo. Spearman rank correlation coefficients with 95% confidence intervals (95% CI) and Bland-Altman plots were constructed to assess agreement. Secondary analyses were performed after categorizing data into quartiles based on participants' estimations of MVC severity.

RESULTS

A total of 54 attending and 53 resident EPs, 156 paramedics, and 34 EMTs were invited to participate in the survey. Of these, 39 (72%) attending and 46 (87%) resident EPs, 107 (69%) paramedics, and 17 (50%) EMTs completed the survey. A total of 183 (88%) surveys were completed in full. The overall Crash Score correlation coefficient between EPs and EMS was 0.98 (95% CI, 0.97-0.99). The Crash Score correlation coefficients for each quartile were 0.86 (0.57-0.97), 0.93 (0.85-0.96), 0.58 (0.16-0.85), and 0.88 (0.66-0.97), respectively. The overall Injury Score correlation coefficient between EPs and EMS was 0.98 (0.88-0.97). The Injury Score correlation coefficients for each quartile were 0.94 (0.48-0.91), 0.76 (0.50-0.92), 0.80 (0.69-1.00), and 0.94 (0.57-0.97), respectively.

CONCLUSION

Although overall agreement between EPs and EMS personnel was excellent, differences in estimation of crash severity and potential for injury were identified among crashes estimated to be moderate in severity.

摘要

目的

确定急诊医生（EP）和院前急救医疗服务（EMS）人员在查看车祸现场照片时，对机动车碰撞（MVC）严重程度及严重受伤可能性的评估是否存在差异。

方法

来自单一急诊医疗系统的主治及住院急诊医生、护理人员和急救医疗技术员（EMT）使用基于网络的调查平台，以10分制李克特量表（碰撞评分）对100张车祸照片的严重程度进行评分，并以0 - 100%的比例（受伤评分）对严重受伤的可能性进行评分。严重受伤定义为颅骨骨折或颅内出血、脊柱骨折或脊髓损伤、胸腔或腹腔内损伤或长骨骨折。碰撞评分和受伤评分被分为急诊医生组和护理人员/急救医疗技术员（EMS）组，并计算每张照片的平均评分。构建了具有95%置信区间（95%CI）的斯皮尔曼等级相关系数和布兰德 - 奥特曼图以评估一致性。在根据参与者对MVC严重程度的估计将数据分类为四分位数后进行了二次分析。

结果

共邀请了54名主治和53名住院急诊医生、156名护理人员和34名急救医疗技术员参与调查。其中，39名（72%）主治急诊医生、46名（87%）住院急诊医生、107名（69%）护理人员和17名（50%）急救医疗技术员完成了调查。总共183份（88%）调查问卷全部完成。急诊医生和EMS之间的总体碰撞评分相关系数为0.98（95%CI，0.97 - 0.99）。每个四分位数的碰撞评分相关系数分别为0.86（0.57 - 0.97）、0.93（0.85 - 0.96）、0.58（0.16 - 0.85）和0.88（0.66 - 0.97）。急诊医生和EMS之间的总体受伤评分相关系数为0.98（0.88 - 0.97）。每个四分位数的受伤评分相关系数分别为0.94（0.48 - 0.91）、0.76（0.50 - 0.92）、0.80（0.69 - 1.00）和0.94（0.57 - 0.97）。