评估创伤团队激活工具识别严重损伤的能力：一项多中心队列研究。
Evaluating the ability of a trauma team activation tool to identify severe injury: a multicentre cohort study.
机构信息
Department of Surgery, St. Olav's University Hospital, 7006, Trondheim, Norway.
Department of Emergency Medicine and Pre-Hospital Services, St. Olav's University Hospital, 7006, Trondheim, Norway.
出版信息
Scand J Trauma Resusc Emerg Med. 2018 Aug 10;26(1):63. doi: 10.1186/s13049-018-0533-y.
BACKGROUND
Sensitive decision making tools should assist prehospital personnel in the triage of injured patients, identifying those who require immediate lifesaving interventions and safely reducing unnecessary under- and overtriage. In 2014 a new trauma team activation (TTA) tool was implemented in Central Norway. The overall objective of this study was to evaluate the ability of the new TTA tool to identify severe injury.
METHODS
This was a multi-center observational cohort study with retrospective data analysis. All patients received by trauma teams at seven hospitals in Central Norway between 01.01.2015 to 31.12.2015 were included. Severe injury was defined as Injury Severity Score (ISS) > 15. Overtriage was defined as the rate of patients with TTA and ISS < 15, whilst patients with TTA and ISS > 15 were defined as correctly triaged.
RESULTS
A total of 1141 patients were identified, of which 998 were eligible for triage criteria analysis. Median age was 35 years (IQR 20-58) and the male proportion was 67%. Mechanism of injury was predominantly blunt trauma (96%) with transport related accidents (62%) followed by falls (22%) the most common. Overall, median injury severity score (ISS) was low and severely injured patients (ISS > 15) comprised 13% of the cohort. Utility of specific TTA criteria were: physiology 20%, anatomical injury 21%, mechanism of injury (MOI) 53% and special causes 6%. Overtriage among all patients was 87%, and for those with physiologic criteria 66%, anatomical injury 82%, mechanism of injury 97% and special causes criteria 92%, respectively.
CONCLUSIONS
Severe injury was infrequent and there was a substantial rate of overtriage. The ability of the TTA tool was relatively insensitive in identifying severe injury, but showed increased performance when utilizing physiologic and anatomical injury criteria. Many of the TTA mechanism of injury criteria might be considered for removal from the triage tool due to substantial rates of overtriage. This has relevance for the proposed development of national Norwegian TTA criteria.
背景
敏感的决策工具应该帮助院前人员对受伤患者进行分类，确定那些需要立即进行救生干预的患者，并安全减少不必要的过度和不足分类。2014 年，挪威中部实施了一种新的创伤小组激活（TTA）工具。这项研究的总体目标是评估新的 TTA 工具识别严重损伤的能力。
方法
这是一项多中心观察性队列研究，采用回顾性数据分析。2015 年 1 月 1 日至 12 月 31 日，挪威中部 7 家医院接收的所有创伤患者均纳入研究。严重损伤定义为损伤严重程度评分（ISS）>15。过度分类定义为 TTA 和 ISS<15 的患者比例，而 TTA 和 ISS>15 的患者则定义为正确分类。
结果
共确定 1141 例患者，其中 998 例符合分诊标准分析。中位年龄为 35 岁（IQR 20-58），男性比例为 67%。损伤机制主要为钝性创伤（96%），交通相关事故（62%）次之，坠落（22%）为最常见的原因。总体而言，中位损伤严重程度评分（ISS）较低，严重损伤患者（ISS>15）占队列的 13%。特定 TTA 标准的应用价值为：生理标准 20%，解剖学损伤标准 21%，损伤机制标准 53%，特殊原因标准 6%。所有患者的过度分类率为 87%，其中生理标准为 66%，解剖学损伤标准为 82%，损伤机制标准为 97%，特殊原因标准为 92%。
结论
严重损伤较为少见，过度分类率较高。TTA 工具识别严重损伤的能力相对较低，但利用生理和解剖学损伤标准后，其性能有所提高。由于过度分类率较高，TTA 工具中的许多损伤机制标准可能需要被删除。这对挪威国家 TTA 标准的制定具有重要意义。
Zotero 插件