Con Jorge, Long Dustin, Sasala Emily, Khan Uzer, Knight Jennifer, Schaefer Greg, Wilson Alison
Department of Surgery, West Virginia University, Morgantown, West Virginia.
Department of Biostatistics, West Virginia University, Morgantown, West Virginia.
J Surg Res. 2015 Oct;198(2):462-7. doi: 10.1016/j.jss.2015.03.077. Epub 2015 Apr 2.
Rural hospitals have variable degrees of involvement within the nationwide trauma system because of differences in resources and operational goals. "Secondary overtriage" refers to the patient who is discharged home shortly after being transferred from another hospital. An analysis of these occurrences is useful to determine the efficiency of the trauma system as a whole.
Data were extracted from a statewide trauma registry from 2007-2012 to include those who were (1) discharged home within 48 h of arrival and (2) did not undergo a surgical procedure. We then identified those who arrived as a transfer before being discharged (secondary overtriage) from those who arrived from the scene. Factors associated with transfers were analyzed using a logistic regression. Injuries were classified based on the need of a specific consultant. Time of arrival to the emergency department was analyzed using 8-h blocks, with the 7 AM-3 PM block as reference.
A total of 19,319 patients fit our inclusion criteria of which 1897 (9.8%) arrived as transfers. Descriptive analysis showed a number of differences between transfers and nontransfers because of our large sample size. Thus, we examined variables that had more clinical significance using logistic regression controlling for age, injury severity score, the type of injury, blood products given, the time of arrival to initial emergency room, and whether a computed tomography scan was obtained initially. Factors associated with being transferred were injury severity score >15, transfusion of packed-red-blood-cells, graveyard-shift arrivals, and neurosurgical, spine, and facial injuries. Patients having a computed tomography scan were less likely to be transferred.
Secondary overtriage may result from the hospital's limited resources. Some of these limitations are the availability of surgical specialists, blood products, and overall coverage during the "graveyard-shift." However, some of these transfers may be appropriate even though patients are ultimately discharged shortly after transfer.
由于资源和运营目标的差异，农村医院在全国创伤系统中的参与程度各不相同。“二次过度分诊”指的是从另一家医院转来后不久即出院回家的患者。对这些情况进行分析有助于确定整个创伤系统的效率。
从2007年至2012年的全州创伤登记处提取数据，纳入那些（1）到达后48小时内出院且（2）未接受外科手术的患者。然后，我们将那些在出院前作为转院患者（二次过度分诊）与那些从现场送来的患者区分开来。使用逻辑回归分析与转院相关的因素。根据是否需要特定专科医生会诊对损伤进行分类。以早上7点至下午3点时间段为参照，按8小时时间段分析到达急诊科的时间。
共有19319名患者符合我们的纳入标准，其中1897名（9.8%）是转院而来。描述性分析显示，由于样本量较大，转院患者和非转院患者之间存在一些差异。因此，我们使用逻辑回归分析了更具临床意义的变量，同时控制了年龄、损伤严重程度评分、损伤类型、输血情况、到达初始急诊室的时间以及是否最初进行了计算机断层扫描。与转院相关的因素包括损伤严重程度评分>15、输注浓缩红细胞、夜间值班到达以及神经外科、脊柱和面部损伤。进行计算机断层扫描的患者转院的可能性较小。
二次过度分诊可能是由于医院资源有限所致。其中一些限制包括外科专家的可用性、血液制品以及夜间值班期间的全面覆盖情况。然而，即使患者最终在转院后不久出院，其中一些转院情况可能也是合适的。
