Olgers T J, Dijkstra R S, Drost-de Klerck A M, Ter Maaten J C
Department of Internal Medicine, Emergency Department, University Medical Centre Groningen, UMCG, Groningen, the Netherlands.
Neth J Med. 2017 Apr;75(3):106-111.
Competency in the Airway Breathing Circulation Disability Exposure (ABCDE) approach is required for working in the emergency department. There is limited knowledge on how often and how completely the ABCDE approach is applied to medical patients. The objectives of this study were to assess the frequency with which the ABCDE approach was used in potentially unstable patients and to determine factors influencing the choice of whether or not to use the ABCDE approach.
This observational pilot study included 270 medical patients admitted to the emergency department and it was observed if and how completely the ABCDE approach was performed. We registered several factors possibly determining its use.
Of the 270 patients included, 206 were identified as possibly unstable patients based on their triage code. The ABCDE approach was used in a minority of these patients (33%). When the ABCDE approach was used, it was done rapidly (generally within 10 minutes) and highly completely (> 80% of needed items). The choice not to use the ABCDE approach was frequently based on a first clinical impression and/or vital signs obtained during triage. The ABCDE approach was used more often with a higher triage code.
We show that the emergency department staff are capable of performing the ABCDE approach rather completely (83%), but it was only used in the minority of potentially unstable patients. Important factors determining this choice were the vital signs on triage and a quick first impression. Whether this adequately selects patients in need for an ABCDE approach is not clear yet.
在急诊科工作需要具备气道、呼吸、循环、残疾评估、暴露情况（ABCDE）评估方法的能力。对于ABCDE评估方法在医疗患者中的应用频率和完整程度，目前了解有限。本研究的目的是评估ABCDE评估方法在潜在不稳定患者中的使用频率，并确定影响是否采用ABCDE评估方法的因素。
这项观察性试点研究纳入了270名入住急诊科的内科患者，观察ABCDE评估方法是否以及执行得有多完整。我们记录了几个可能决定其使用的因素。
在纳入的270名患者中，根据分诊代码，有206名被确定为可能不稳定的患者。这些患者中少数（33%）使用了ABCDE评估方法。当使用ABCDE评估方法时，操作迅速（一般在10分钟内）且完成度很高（超过所需项目的80%）。不采用ABCDE评估方法的决定通常基于分诊时获得的初步临床印象和/或生命体征。分诊代码越高，ABCDE评估方法的使用频率越高。
我们发现急诊科工作人员能够较为完整地执行ABCDE评估方法（83%），但该方法仅在少数潜在不稳定患者中使用。决定这一选择的重要因素是分诊时的生命体征和快速的初步印象。这是否能充分筛选出需要ABCDE评估方法的患者尚不清楚。
