Bressan Silvia, Franklin Katherine L, Jowett Helen E, King Sebastian K, Oakley Ed, Palmer Cameron S
The Royal Children's Hospital Melbourne, Melbourne, Victoria, Australia Murdoch Children's Research Institute, Victoria, Australia Department of Woman's and Child's Health, University of Padova, Padova, Italy.
The Royal Children's Hospital Melbourne, Melbourne, Victoria, Australia.
Emerg Med J. 2015 Sep;32(9):716-21. doi: 10.1136/emermed-2014-203998. Epub 2014 Dec 18.
Trauma team activation (TTA) is a well-recognised standard of care to provide rapid stabilisation of patients with time-critical, life-threatening injuries. TTA is associated with a substantial use of valuable hospital resources that may adversely impact upon the care of other patients if not carefully balanced. This study aimed to determine which of the two outcome measures would be a better standard for assessing the appropriateness of TTA at a paediatric centre: retrospective major trauma classification as defined within our state, and the use of emergency department high-level resources as recently published by Falcone et al (Falcone Interventions; FI).
Trauma registry data and patients' charts between February 2011 and June 2013 were reviewed. Over-triage and under-triage rates for TTA, using both major trauma and FIs as outcome measures, were compared.
Totally, 280 patients received TTA, 243 met major trauma definition and 102 received one or more FIs. The rates of over-triage and under-triage were 39.7% (95% CI 35.0 to 44.6%) and 30.5% (95% CI 26.2 to 35.2%), when the major trauma definition was used as the outcome measure, and 67.5% (95% CI 62.2 to 72.5%) and 10.8% (95% CI 7.9 to 14.8%) when FI was used. Only 17.1% (95% CI 11.4% to 24.7%) of the under-triaged patients using the major trauma definition received one or more FIs.
Assessment of TTA appropriateness varied significantly based on the outcome measure used. FIs better reflected the use of acute-care TTA-related resources compared with the major trauma definition, and it should be used as the gold standard to prospectively assess and refine TTA criteria.
创伤团队启动（TTA）是一种公认的护理标准，用于对有时间紧迫性、危及生命损伤的患者进行快速稳定治疗。TTA会大量使用宝贵的医院资源，如果没有仔细权衡，可能会对其他患者的护理产生不利影响。本研究旨在确定在一家儿科中心，两种结局指标中哪一种更适合作为评估TTA合理性的标准：按照本州定义的回顾性严重创伤分类，以及Falcone等人最近发表的急诊科高级别资源使用情况（Falcone干预措施；FI）。
回顾了2011年2月至2013年6月期间的创伤登记数据和患者病历。比较了以严重创伤和FI作为结局指标时TTA的过度分诊率和分诊不足率。
共有280例患者接受了TTA，243例符合严重创伤定义，102例接受了一项或多项FI。当以严重创伤定义作为结局指标时，过度分诊率和分诊不足率分别为39.7%（95%CI 35.0至44.6%）和30.5%（95%CI 26.2至35.2%）；当使用FI时，分别为67.5%（95%CI 62.2至72.5%）和10.8%（95%CI 7.9至14.8%）。按照严重创伤定义分诊不足的患者中，只有17.1%（95%CI 11.4%至24.7%）接受了一项或多项FI。
根据所使用的结局指标，对TTA合理性的评估存在显著差异。与严重创伤定义相比，FI能更好地反映与急性护理TTA相关资源的使用情况，应将其作为前瞻性评估和完善TTA标准的金标准。
