Newgard Craig D, Fu Rongwei, Lerner E Brooke, Daya Mohamud, Jui Jonathan, Wittwer Lynn, Schmidt Terri A, Zive Dana, Bulger Eileen M, Sahni Ritu, Warden Craig, Kuppermann Nathan
Prehosp Emerg Care. 2017 Sep-Oct;21(5):545-555. doi: 10.1080/10903127.2017.1308612. Epub 2017 May 1.
To compare the sensitivity of current field triage practices for identifying high-risk trauma patients to strict guideline adherence, including changes in triage specificity, ambulance transport patterns, and trauma center volumes.
This was a pre-planned secondary analysis of an out-of-hospital prospective cohort of injured children and adults transported by 44 EMS agencies to 28 trauma and non-trauma hospitals in 7 Northwest U.S. counties from January 1, 2011 through December 31, 2011. Outcomes included Injury Severity Score (ISS) ≥16 (primary) and early critical resource use. Strict adherence of the triage guidelines was based on evidence in the EMS chart for patients meeting any current field triage criteria, calculated with and without strict interpretation of the age criterion (<15 or >55 years). Due to the probability sampling nature of the cohort, strata and weights were included in all analyses.
17,633 injured patients were transported by EMS (weighted to represent 53,487 transported patients), including 3.1% with ISS ≥16 and 1.7% requiring early critical resources. Field triage sensitivity for identifying patients with ISS ≥16 increased from the current 66.2% (95% CI 60.2-71.7%) to 87.3% (95% CI 81.9-91.2%) for strict adherence without age and to 91.0% (95% CI 86.4-94.2%) for strict adherence with age. Specificity decreased with increasing adherence, from 87.8% (current) to 47.6% (strict adherence without age) and 35.8% (strict adherence with age). Areas under the curve (AUC) were 0.78, 0.73, and 0.72, respectively. Results were similar for patients requiring early critical resources. We estimate the number of triage-positive patients transported each year by EMS to an individual major trauma center (on average) to increase from 1,331 (current) to 5,139 (strict adherence without age) and to 6,256 (strict adherence with age).
The low sensitivity of current triage practices would be expected to improve with strict adherence to current triage guidelines, with a commensurate decrease in triage specificity and an increase in the number of triage-positive patients transported to major trauma centers.
比较当前现场分诊方法在识别高危创伤患者方面的敏感性与严格遵循指南的情况，包括分诊特异性的变化、救护车转运模式以及创伤中心接收量。
这是一项对院前前瞻性队列进行的预先计划的二次分析，该队列研究对象为2011年1月1日至2011年12月31日期间由44个急救医疗服务（EMS）机构转运至美国西北部7个县的28家创伤和非创伤医院的受伤儿童及成人。结局指标包括损伤严重度评分（ISS）≥16（主要指标）以及早期关键资源的使用情况。对于符合任何当前现场分诊标准的患者，严格遵循分诊指南基于EMS病历中的证据，分别计算有无严格解读年龄标准（<15岁或>55岁）时的情况。由于该队列的概率抽样性质，所有分析均纳入了分层和权重。
EMS共转运了17,633名受伤患者（加权后代表53,487名转运患者），其中3.1%的患者ISS≥16，1.7%的患者需要早期关键资源。识别ISS≥16患者的现场分诊敏感性，从当前的66.2%（95%可信区间60.2 - 71.7%）在不考虑年龄严格遵循指南时提高到87.3%（95%可信区间81.9 - 91.2%），在考虑年龄严格遵循指南时提高到91.0%（95%可信区间86.4 - 94.2%）。特异性随着遵循程度的增加而降低，从87.8%（当前）降至47.6%（不考虑年龄严格遵循指南）和35.8%（考虑年龄严格遵循指南）。曲线下面积（AUC）分别为0.78、0.73和0.72。对于需要早期关键资源的患者，结果类似。我们估计，EMS每年转运至单个主要创伤中心的分诊阳性患者数量（平均）将从1331名（当前）增加到5139名（不考虑年龄严格遵循指南）以及6256名（考虑年龄严格遵循指南）。
预计严格遵循当前分诊指南可改善当前分诊方法的低敏感性，同时分诊特异性相应降低，转运至主要创伤中心的分诊阳性患者数量增加。
