Whitehead Jesse, Roskruge Matt, Tan Colin, Smith Alistair, Christey Grant
Midland Trauma System, Waikato DHB, Hamilton.
School of Economics and Finance, Massey University, Auckland.
N Z Med J. 2018 Feb 23;131(1470):71-78.
Pre-hospital triage strategies aim to identify the type and extent of patient injuries and ensure that they are transferred to the most appropriate trauma centres. Despite the importance of appropriate pre-hospital transport, there is little evidence base to assist medical staff on optimal destination policy for emergent pre-hospital transport. This paper explores the spatial relationship of patient transfers prior to the implementation of the Midland Pre-Hospital Trauma Destination Matrix in New Zealand, and is a retrospective view of practice against a destination policy that was applied after the study period.
We use data obtained from the Midland Trauma Registry merged with Global Positioning System (GPS) data from St John and Land Information New Zealand Data Service on major trauma occurring in 2014 and 2015. Using ArcGIS, data were analysed for spatial relationships between factors associated with major trauma events and pre-hospital transportation.
In the retrospective analysis of 162 major trauma patients, 107 (66%) were transported to a hospital that matched the destination specified in the Matrix, and 55 (34%) were transported to a non-Matrix designated hospital.
Approximately one-third of patients were not directly transported to the preferred definitive care hospital subsequently defined in the Midland Pre-Hospital Trauma Destination Matrix. Ongoing monitoring of the pre-hospital transportation system and the implementation of a formal pre-hospital transport policy may improve the efficiency of the Midland Trauma System. Future studies should examine the possible reasons for variations in triage decisions across the Midland Region.
院前分诊策略旨在识别患者损伤的类型和程度，并确保他们被转运至最合适的创伤中心。尽管适当的院前转运很重要，但几乎没有证据基础可协助医护人员制定紧急院前转运的最佳目的地政策。本文探讨了新西兰实施中部地区院前创伤目的地矩阵之前患者转运的空间关系，并且是针对研究期后应用的目的地政策对实践的回顾性观察。
我们使用从中部地区创伤登记处获得的数据，与圣约翰急救组织的全球定位系统（GPS）数据以及新西兰土地信息数据服务中心关于2014年和2015年发生的重大创伤的数据合并。使用ArcGIS分析与重大创伤事件和院前运输相关因素之间的空间关系。
在对162例重大创伤患者的回顾性分析中，107例（66%）被转运至与矩阵中指定目的地相符的医院，55例（34%）被转运至非矩阵指定的医院。
约三分之一的患者未被直接转运至随后在中部地区院前创伤目的地矩阵中确定的首选确定性治疗医院。对院前运输系统进行持续监测并实施正式的院前运输政策可能会提高中部地区创伤系统的效率。未来的研究应检查中部地区分诊决策差异的可能原因。
