Department of Emergency Medicine, Denver Health Medical Center, Denver, CO, USA; Department of Emergency Medicine, University of Colorado School of Medicine, Aurora, CO, USA.
Department of Emergency Medicine, Denver Health Medical Center, Denver, CO, USA.
Am J Emerg Med. 2019 Jun;37(6):1108-1113. doi: 10.1016/j.ajem.2018.08.073. Epub 2018 Aug 30.
Early identification of trauma patients who need specialized healthcare resources may facilitate goal-directed resuscitation and effective secondary triage.
To estimate associations between Denver Emergency Department (ED) Trauma Organ Failure (TOF) Score and healthcare resource utilization.
Retrospective study of adult trauma patients at Denver Health Medical Center. The outcome was resource utilization including: intensive care unit (ICU) length of stay (LOS), hospital LOS, procedures, and costs. Multivariable regression analyses were used to estimate associations between moderate- or high-risk patients, as determined by the Denver ED TOF Score, and healthcare resource utilization.
We included 3000 patients with a median age of 42 (IQR 27-56) years, 71% male, median injury severity score 9 (IQR 5-16), and 83% blunt mechanism. Among the cohort, 1379 patients (46%) were admitted to the ICU and 122 (4%) died. The adjusted relative risk for high- and moderate-risk as compared to low risk for number of procedures performed was 2.31 (95% CI 2.07-2.57) and 1.80 (95% CI 1.59-2.03) respectively; ICU LOS was 2.87 (95% CI 2.70-3.05) and 1.71 (95% CI 1.60-1.83) respectively; hospital LOS was 3.33 (95% CI 3.21-3.45) and 1.97 (95% CI 1.90-2.05) respectively. The adjusted geometric mean for high-, moderate-, and low-risk for costs was $48,881 (95% CI $43,799-$54,552), $27,890 (95% CI $25,460-$30,551), and $12,983 (95% CI $12,493-$13,492), respectively.
The Denver ED TOF Score predicts healthcare resource utilization, and is a useful bedside tool to identify patients early after injury that are likely to require significant healthcare resources and specialized trauma care.
早期识别需要专科医疗资源的创伤患者，有助于目标导向复苏和有效的二次分诊。
评估丹佛急诊部（ED）创伤器官衰竭（TOF）评分与医疗资源利用之间的关系。
这是丹佛健康医疗中心成年创伤患者的回顾性研究。结局为资源利用，包括：重症监护病房（ICU）住院时间（LOS）、医院 LOS、操作和费用。多变量回归分析用于估计由丹佛 ED TOF 评分确定的中危或高危患者与医疗资源利用之间的关系。
共纳入 3000 例患者，中位年龄 42（IQR 27-56）岁，71%为男性，损伤严重程度评分中位数 9（IQR 5-16），83%为钝性机制。队列中，1379 例（46%）患者收入 ICU，122 例（4%）死亡。与低危相比，高危和中危患者进行操作的相对风险分别为 2.31（95%CI 2.07-2.57）和 1.80（95%CI 1.59-2.03）；ICU LOS 分别为 2.87（95%CI 2.70-3.05）和 1.71（95%CI 1.60-1.83）；医院 LOS 分别为 3.33（95%CI 3.21-3.45）和 1.97（95%CI 1.90-2.05）。高、中、低风险患者的调整后几何平均值为 48881 美元（95%CI 43799-54552）、27890 美元（95%CI 25460-30551）和 12983 美元（95%CI 12493-13492）。
丹佛 ED TOF 评分预测医疗资源利用，是一种有用的床边工具，可在受伤后早期识别可能需要大量医疗资源和专科创伤护理的患者。
