Staudenmayer Kristan, Wang N Ewen, Weiser Thomas G, Maggio Paul, Mackersie Robert C, Spain David, Hsia Renee Y
Department of Surgery, Stanford University School of Medicine, Stanford, California, USA.
Am Surg. 2016 Apr;82(4):356-61.
The target rate for trauma undertriage is <5 per cent, but rates are as high as 30 to 40 per cent in many trauma systems. We hypothesized that high undertriage rates were due to the tendency to undertriage injured elderly patients and a growing elderly population. We conducted a retrospective analysis of all hospital visits in California using the Office of Statewide Health Planning and Development Database over a 5-year period. All hospital admissions and emergency department visits associated with injury were longitudinally linked. The primary outcome was triage pattern. Triage patterns were stratified across three dimensions: age, mechanism of injury, and access to care. A total of 60,182 severely injured patients were included in the analysis. Fall-related injuries were frequently undertriaged compared with injuries from motor vehicle collisions (MVCs) and penetrating trauma (52% vs 12% and 10%, respectively). This pattern was true for all age groups. Conversely, MVCs and penetrating traumas were associated with high rates of overtriage (>70% for both). In conclusion, in contrast to our hypothesis, we found that triage is largely determined by mechanism of injury regardless of injury severity. High rates of undertriage are largely due to the undertriage of fall-related injuries, which occurs in both younger and older adults. Patients injured after MVCs and penetrating trauma victims are brought to trauma centers regardless of injury severity, resulting in high rates of overtriage. These findings suggest an opportunity to improve trauma system performance.
创伤低检率的目标值应低于5%，但在许多创伤救治系统中，该比例高达30%至40%。我们推测，高低检率是由于对受伤老年患者进行低检的倾向以及老年人口不断增加所致。我们使用全州卫生规划和发展办公室数据库，对加利福尼亚州5年内的所有医院就诊情况进行了回顾性分析。所有与损伤相关的医院入院和急诊科就诊情况进行了纵向关联。主要结局是分诊模式。分诊模式在三个维度上进行分层：年龄、损伤机制和获得医疗服务的途径。共有60182名重伤患者纳入分析。与机动车碰撞（MVC）和穿透性创伤导致的损伤相比，跌倒相关损伤经常被低检（分别为52% vs 12%和10%）。所有年龄组均呈现这种模式。相反，MVC和穿透性创伤与高过度检率相关（两者均>70%）。总之，与我们的假设相反，我们发现分诊在很大程度上取决于损伤机制，而与损伤严重程度无关。高低检率主要是由于跌倒相关损伤的低检，这在年轻人和老年人中均有发生。MVC后受伤的患者和穿透性创伤受害者无论损伤严重程度如何都被送往创伤中心，导致高过度检率。这些发现表明有机会改善创伤救治系统的性能。
