Lynch Kevin T, Essig Rachael M, Long Dustin M, Wilson Alison, Con Jorge
School of Medicine, West Virginia University, Morgantown, West Virginia.
Department of Biostatistics, West Virginia University, Morgantown, West Virginia.
J Surg Res. 2016 Aug;204(2):460-466. doi: 10.1016/j.jss.2016.05.035. Epub 2016 May 26.
Secondary overtriage (SO) refers to the interfacility transfer of trauma patients who are rapidly discharged home without surgical intervention by the receiving institution. SO imposes a financial hardship on patients and strains trauma center resources. Most studies on SO have been conducted from the perspective of the receiving hospital, which is usually a level 1 trauma center. Having previously studied SO from the referring rural hospital's perspective, we sought to identify variables contributing to SO at the national level.
Using data from the 2008-2012 National Trauma Data Bank, we isolated patients transferred to level 1 trauma centers who were: (1) discharged home within 48 h and (2) did not undergo any surgical procedure. This population was subsequently compared with similar patients treated at and discharged directly from level 3 and 4 centers. Multivariate logistic regression analysis was used to isolate variables that independently influenced a patient's risk of undergoing SO. Injury patterns were characterized by use of subspecialty consultants.
A total of 99,114 patients met inclusion criteria, of which 13.2% were discharged directly from level 3 or 4 trauma centers, and 86.8% of them were transferred to a level 1 trauma center before discharge. The mean Injury Severity Score of the nontransfer and transfer groups was 5.4 ± 4.5 and 7.3 ± 5.7, respectively. Multivariate regression analysis showed that Injury Severity Score > 15, alcoholism, smoking, drug use, and certain injury patterns involving the head, vertebra, and face were associated with being transferred. In this minimally injured population, factors protective against transfers were: age > 65 y, female gender, systolic blood pressure <80, a head computed tomography scan and orthopedic injuries.
SO results from the complex interplay of variables including patient demographics, facility characteristics, and injury type. The inability to exclude a potentially devastating neurologic injury seems to drive SO.
二次过度分诊（SO）是指创伤患者在接收机构未进行手术干预的情况下被迅速出院并转至其他医疗机构。SO给患者带来经济困难，并使创伤中心资源紧张。大多数关于SO的研究是从接收医院（通常是一级创伤中心）的角度进行的。我们之前从转诊的农村医院的角度研究了SO，现在试图确定在全国范围内导致SO的变量。
利用2008 - 2012年国家创伤数据库的数据，我们筛选出转至一级创伤中心的患者，这些患者需满足：（1）在48小时内出院；（2）未接受任何手术。随后将这一人群与在三级和四级中心接受治疗并直接出院的类似患者进行比较。采用多因素逻辑回归分析来确定独立影响患者发生SO风险的变量。通过使用专科顾问来描述损伤模式。
共有99114名患者符合纳入标准，其中13.2%直接从三级或四级创伤中心出院，86.8%在出院前转至一级创伤中心。未转院组和转院组的平均损伤严重度评分分别为5.4±4.5和7.3±5.7。多因素回归分析显示，损伤严重度评分>15、酗酒、吸烟、吸毒以及某些涉及头部、脊椎和面部的损伤模式与转院有关。在这个轻伤人群中，防止转院的因素包括：年龄>65岁、女性、收缩压<80、头部计算机断层扫描和骨科损伤。
SO是由包括患者人口统计学、机构特征和损伤类型等变量的复杂相互作用导致的。无法排除潜在的毁灭性神经损伤似乎是导致SO的原因。
