van Rein Eveline A J, Sadiqi Said, Lansink Koen W W, Lichtveld Rob A, van Vliet Risco, Oner F Cumhur, Leenen Luke P H, van Heijl Mark
Utrecht Trauma Centre, University Medical Centre Utrecht, Suite: G04.228, Heidelberglaan 100, 3584 CX, Utrecht, The Netherlands.
Department of Orthopaedic Surgery, University Medical Centre Utrecht, Utrecht, The Netherlands.
Eur J Trauma Emerg Surg. 2020 Feb;46(1):131-146. doi: 10.1007/s00068-018-1006-8. Epub 2018 Sep 20.
Severely injured patients should be treated at higher-level trauma centres, to improve chances of survival and avert life-long disabilities. Emergency medical service (EMS) providers must try to determine injury severity on-scene, using a prehospital trauma triage protocol, and decide the most appropriate type of trauma centre. The objective of this study is to investigate the role of EMS provider judgment in the prehospital triage process of trauma patients, by analysing the compliance rate to the protocol and administering a questionnaire among EMS providers.
All trauma patients transported to a trauma centre in two different regions of the Netherlands were analysed. Compliance rate was based on the number of patients meeting the triage criteria and transported to the corresponding level trauma centre. The questionnaire was administered among EMS providers. Descriptive statistics were used to analyse the data.
For adult patients, the compliance rate to the level I criteria of the triage protocol was 72% in Central Netherlands and 42% in Brabant. For paediatric patients, this was 63% and 38% in Central Netherlands and Brabant, respectively. The judgment on injury severity was mostly based on the injury-type criteria. Additionally, the distance to a level I trauma centre influenced the decision for destination facility in the Brabant region.
The compliance rate varied between regions. Improvement of prehospital trauma triage depends on the accuracy of the protocol and compliance rate. A new protocol, including EMS provider judgment, might be the key to improvement in the prehospital trauma triage quality.
重伤患者应在更高级别的创伤中心接受治疗，以提高生存几率并避免终身残疾。紧急医疗服务（EMS）提供者必须尝试在现场使用院前创伤分诊方案确定损伤严重程度，并决定最合适的创伤中心类型。本研究的目的是通过分析对该方案的依从率并对EMS提供者进行问卷调查，来调查EMS提供者的判断在创伤患者院前分诊过程中的作用。
对转运至荷兰两个不同地区创伤中心的所有创伤患者进行分析。依从率基于符合分诊标准并转运至相应级别创伤中心的患者数量。对EMS提供者进行问卷调查。使用描述性统计分析数据。
对于成年患者，荷兰中部地区对分诊方案一级标准的依从率为72%，布拉班特地区为42%。对于儿科患者，荷兰中部地区和布拉班特地区的这一比例分别为63%和38%。对损伤严重程度的判断主要基于损伤类型标准。此外，到一级创伤中心的距离影响了布拉班特地区对目的地医疗机构的决策。
各地区的依从率有所不同。院前创伤分诊的改善取决于方案的准确性和依从率。一个包括EMS提供者判断的新方案可能是提高院前创伤分诊质量的关键。
