Xiang Huiyun, Wheeler Krista Kurz, Groner Jonathan Ira, Shi Junxin, Haley Kathryn Jo
Center for Injury Research and Policy, The Research Institute at Nationwide Children's Hospital; Ohio State University College of Medicine.
Center for Injury Research and Policy, The Research Institute at Nationwide Children's Hospital.
Am J Emerg Med. 2014 Sep;32(9):997-1004. doi: 10.1016/j.ajem.2014.05.038. Epub 2014 Jun 2.
There is evidence that regionalized trauma care and appropriate triage of major trauma patients improve patient outcomes. However, the national rate of undertriage and diagnoses of undertriaged patients are unknown.
We used the 2010 Nationwide Emergency Department Sample to estimate the national rate of undertriage, identify the prevalent diagnoses, and conduct a simulation analysis of the capacity increase required for level I and II trauma centers (TCs) to accommodate undertriaged patients. Undertriaged patients were those with major trauma, injury severity score ≥ 16, who received definitive care at nontrauma centers (NTCs), or level III TCs. The rate of undertriage was calculated with those receiving definitive care at an NTC center or level III center as a fraction of all major trauma patients.
The estimated number of major trauma patient discharges in 2010 was 232448. Level of care was known for 197702 major trauma discharges, and 34.0% were undertriaged in emergency departments (EDs). Elderly patients were at a significantly higher risk of being undertriaged. Traumatic brain injury (TBI) was the most common diagnosis, 40.2% of the undertriaged patient diagnoses. To accommodate all undertriaged patients, level I and II TCs nationally would have to increase their capacity by 51.5%.
We found that more than one-third of US ED major trauma patients were undertriaged, and more than 40% of undertriaged diagnoses were TBIs. A significant capacity increase at level I and II TCs to accommodate these patients appears not feasible.
有证据表明，创伤的区域化治疗以及对严重创伤患者进行适当分诊可改善患者预后。然而，全国范围内的分诊不足率以及分诊不足患者的诊断情况尚不清楚。
我们使用2010年全国急诊科样本估计全国分诊不足率，确定常见诊断，并对I级和II级创伤中心（TCs）容纳分诊不足患者所需的能力增加进行模拟分析。分诊不足患者是指那些有严重创伤、损伤严重度评分≥16，在非创伤中心（NTCs）或III级TCs接受确定性治疗的患者。分诊不足率的计算方法是，在NTC中心或III级中心接受确定性治疗的患者数占所有严重创伤患者数的比例。
2010年估计的严重创伤患者出院人数为232448例。已知197702例严重创伤出院患者的护理级别，其中34.0%在急诊科被分诊不足。老年患者分诊不足的风险显著更高。创伤性脑损伤（TBI）是最常见的诊断，占分诊不足患者诊断的40.2%。为了容纳所有分诊不足的患者，全国范围内的I级和II级TCs将不得不将其能力提高51.5%。
我们发现，美国急诊科超过三分之一的严重创伤患者被分诊不足，且超过40%的分诊不足诊断为TBI。I级和II级TCs显著增加能力以容纳这些患者似乎不可行。
