van Rein Eveline A J, Houwert R Marijn, Gunning Amy C, Lichtveld Rob A, Leenen Luke P H, van Heijl Mark
From the Department of Traumatology (E.A.J.V.R., A.C.G., L.P.H.L., M.V.H.), University Medical Center Utrecht, Utrecht, The Netherlands; Utrecht Trauma Center (R.M.H.), Utrecht, The Netherlands; and Regional Ambulance Facilities Utrecht (R.L.), RAVU, Utrecht, The Netherlands.
J Trauma Acute Care Surg. 2017 Aug;83(2):328-339. doi: 10.1097/TA.0000000000001516.
Prehospital trauma triage ensures proper transport of patients at risk of severe injury to hospitals with an appropriate corresponding level of trauma care. Incorrect triage results in undertriage and overtriage. The American College of Surgeons Committee on Trauma recommends an undertriage rate below 5% and an overtriage rate below 50% for prehospital trauma triage protocols. To find the most accurate prehospital trauma triage protocol, a clear overview of all currently available protocols and corresponding outcomes is necessary.
The aim of this systematic review was to evaluate the current literature on all available prehospital trauma triage protocols and determine accuracy of protocol-based triage quality in terms of sensitivity and specificity.
A search of Pubmed, Embase, and Cochrane Library databases was performed to identify all studies describing prehospital trauma triage protocols before November 2016. The search terms included "trauma," "trauma center," or "trauma system" combined with "triage," "undertriage," or "overtriage." All studies describing protocol-based triage quality were reviewed. To assess the quality of these type of studies, a new critical appraisal tool was developed.
In this review, 21 articles were included with numbers of patients ranging from 130 to over 1 million. Significant predictors for severe injury were: vital signs, suspicion of certain anatomic injuries, mechanism of injury, and age. Sensitivity ranged from 10% to 100%; specificity from 9% to 100%. Nearly all protocols had a low sensitivity, thereby failing to identify severely injured patients. Additionally, the critical appraisal showed poor quality of the majority of included studies.
This systematic review shows that nearly all protocols are incapable of identifying severely injured patients. Future studies of high methodological quality should be performed to improve prehospital trauma triage protocols.
Systematic review, level III.
院前创伤分诊可确保将有严重受伤风险的患者妥善转运至具备相应创伤救治水平的医院。分诊错误会导致漏诊和过度分诊。美国外科医师学会创伤委员会建议，院前创伤分诊方案的漏诊率应低于5%，过度分诊率应低于50%。为找到最准确的院前创伤分诊方案，有必要对所有现有方案及相应结果进行清晰概述。
本系统评价的目的是评估有关所有现有院前创伤分诊方案的当前文献，并根据敏感性和特异性确定基于方案的分诊质量的准确性。
检索了PubMed、Embase和Cochrane图书馆数据库，以识别2016年11月之前描述院前创伤分诊方案的所有研究。检索词包括“创伤”“创伤中心”或“创伤系统”，并与“分诊”“漏诊”或“过度分诊”相结合。对所有描述基于方案的分诊质量的研究进行了综述。为评估这类研究的质量，开发了一种新的批判性评价工具。
本综述纳入了21篇文章，患者人数从130至超过100万不等。严重损伤的重要预测因素包括：生命体征、对某些解剖损伤的怀疑、损伤机制和年龄。敏感性范围为10%至100%；特异性范围为9%至100%。几乎所有方案的敏感性都较低，因此未能识别出严重受伤的患者。此外，批判性评价显示，大多数纳入研究的质量较差。
本系统评价表明，几乎所有方案都无法识别严重受伤的患者。应开展方法学质量高的未来研究，以改进院前创伤分诊方案。
系统评价，III级。
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