Shawhan Robert R, McVay Derek P, Casey Linda, Spears Tara, Steele Scott R, Martin Matthew J
Department of Surgery, Madigan Army Medical Center, 9040-A Fitzsimmons Drive, Tacoma, WA 98431, USA.
Department of Surgery, Madigan Army Medical Center, 9040-A Fitzsimmons Drive, Tacoma, WA 98431, USA; Department of Surgery, Legacy Emanuel Medical Center, Portland, OR, USA.
Am J Surg. 2015 May;209(5):856-62; discussion 862-3. doi: 10.1016/j.amjsurg.2015.01.008. Epub 2015 Feb 19.
Standard triage systems result in high rates of overtriage to achieve acceptably low undertriage. We previously validated optimal triage variables and used these to implement a new simplified triage system (NEW) at our hospital.
All trauma entries from May 2010 to Feb 2013 were prospectively reviewed. Calculation of the undertriage and overtriage rates was based on the need for any urgent or life-saving intervention.
We identified 704 trauma patients. Level 1 activations were reduced from 32% (OLD) to 19% in the NEW system (P < .05). Overtriage was reduced from 79% (OLD) to 44% in the NEW system (P < .01). The undertriage rate was 1.6% in the NEW system, compared with 1.2% in the OLD system (P = nonsignificant). Of all patients, 14% (63) required a life-saving intervention. There were no deaths among undertriaged patients.
The NEW simplified triage system significantly reduced the rate of overtriage, while safely maintaining a low undertriage rate.
标准分诊系统导致过度分诊率较高，以实现可接受的低漏诊率。我们之前验证了最佳分诊变量，并在我院使用这些变量实施了一种新的简化分诊系统（NEW）。
对2010年5月至2013年2月期间所有创伤病例进行前瞻性回顾。漏诊率和过度分诊率的计算基于是否需要任何紧急或挽救生命的干预措施。
我们共识别出704例创伤患者。在新系统中，一级激活率从32%（旧系统）降至19%（P < 0.05）。新系统中的过度分诊率从79%（旧系统）降至44%（P < 0.01）。新系统的漏诊率为1.6%，而旧系统为1.2%（P = 无显著性差异）。所有患者中，14%（63例）需要进行挽救生命的干预。漏诊患者中无死亡病例。
新的简化分诊系统显著降低了过度分诊率，同时安全地维持了低漏诊率。
