Kantonsspital Aarau Traumatology, Tellstrasse 25, CH-5001, Aarau, Switzerland.
Amsler Consulting, Gundeldingerrain 111, CH-4059, Basel, Switzerland.
Scand J Trauma Resusc Emerg Med. 2018 Apr 24;26(1):32. doi: 10.1186/s13049-018-0498-x.
No consensus exists in the literature on the use of uniform emergency room trauma team activation criteria (ERTTAC). Today excessive over- or undertriage rates continue to be a challenge for most trauma centres. Application of ERTTAC, published for use in the German TraumaNetwork DGU, at a Swiss trauma centre resulted in a high overtriage rate. The aim of the investigation was to analyse the ERTTAC in detail with the intention of possible improvement.
The investigation included consecutive adult (age > 15 years) trauma patients treated at the emergency department of a level II trauma centre from 01.01.2013-31.12.2015. All data were collected prospectively. To identify over- and undertriage, patients with an Injury Severity Score (ISS) > 15 were defined as requiring specific emergency room (ER) management. ANOVA, Student's t-test and chi-square analysis were used for statistical analysis with mean values ± standard deviation.
1378 adult injured (64% male) received ER trauma team treatment (mean age 48.3 ± 21.2 years; ISS 9.7 ± 9.6) during the observation period. Of those, 326 ER patients (23.7%) were diagnosed with an ISS > 15, which proved to be an overtriage of 76.3%. 80/406 trauma patients with an ISS > 15 were not referred to the ER, resulting in an actual undertriage rate of 19.7%, mainly because the criteria list was not observed. Effectively applying ERTTAC according to the protocol in all cases would have reduced undertriage to 2.0% (8/406). The most frequent trigger for trauma team activation was injury mechanism (65%). A simulation revealed that omitting the criterion 'passenger of car or truck' (n = 326) would have prevented overtriage in 257 cases, as such lowering overtriage rate to 62.4% and at the same time increasing undertriage by only 8 cases to 7.1%.
Application of ERTTAC as published for TraumaNetwork DGU resulted in a lower undertriage but higher overtriage rate than recommended by the American College of Surgeons. Omitting the criterion 'passenger of car or truck' markedly improved overtriage with only a minimal increase in undertriage.
NCT02165137 ; retrospectively registered 11. June 2014.
在文献中，对于使用统一的急诊创伤小组激活标准（ERTTAC），尚未达成共识。如今，大多数创伤中心仍然面临过度或不足分诊的挑战。在瑞士的一家创伤中心应用德国创伤网络 DGU 发布的 ERTTAC 导致了高过度分诊率。该研究的目的是详细分析 ERTTAC，以期进行可能的改进。
该研究纳入了 2013 年 1 月 1 日至 2015 年 12 月 31 日在二级创伤中心急诊接受治疗的连续成年（年龄＞15 岁）创伤患者。所有数据均前瞻性收集。为了确定过度和不足分诊，将损伤严重程度评分（ISS）＞15 的患者定义为需要特定急诊室（ER）管理。使用平均值±标准差进行方差分析、学生 t 检验和卡方分析进行统计学分析。
在观察期间，1378 名成年受伤者（64%为男性）接受了急诊创伤小组治疗（平均年龄 48.3±21.2 岁；ISS 9.7±9.6）。其中，326 名 ER 患者（23.7%）被诊断为 ISS＞15，这证明了过度分诊率为 76.3%。80/406 ISS＞15 的创伤患者未被转至 ER，实际不足分诊率为 19.7%，主要是因为未遵循标准清单。如果在所有情况下都按照方案有效应用 ERTTAC，不足分诊率将降至 2.0%（8/406）。创伤小组激活的最常见触发因素是损伤机制（65%）。模拟表明，省略标准“汽车或卡车乘客”（n=326）可防止 257 例过度分诊，从而将过度分诊率降低至 62.4%，同时仅增加 8 例不足分诊至 7.1%。
应用 DGU 发布的 ERTTAC 导致的不足分诊率低于美国外科医师学院推荐的标准，但过度分诊率更高。省略“汽车或卡车乘客”标准可显著改善过度分诊，而不足分诊仅略有增加。
NCT02165137；2014 年 6 月 11 日回顾性注册。
