Lampi Maria, Junker Johan P E, Tabu John S, Berggren Peter, Jonson Carl-Oscar, Wladis Andreas
Center for Disaster Medicine and Traumatology, and Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden.
Department of Disaster Risk Management, Moi University College of Health and Science, Eldoret, Kenya.
BMC Emerg Med. 2018 Nov 29;18(1):49. doi: 10.1186/s12873-018-0200-7.
Improved trauma management can reduce the time between injury and medical interventions, thus decreasing morbidity and mortality. Triage at the emergency department is essential to ensure prioritization and timely assessment of injured patients. The aim of the present study was to investigate how a lack of formal triage system impacts timely intervention and mortality in a sub-Saharan referral hospital. Further, the study attempts to assess potential benefits of triage towards efficient management of trauma patients in one middle income country.
A prospective descriptive study was conducted. Adult trauma patients admitted to the emergency department during an 8-month period at Moi Teaching and Referral Hospital in Eldoret, Kenya, were included. Mode of arrival and vital parameters were registered. Variables included in the analysis were Injury Severity Score, time before physician's assessment, length of hospital stay, and mortality. The patients were retrospectively categorized according to the Rapid Emergency Triage and Treatment System (RETTS) from patient records.
A total of 571 patients were analyzed, with a mean Injury Severity Score of 12.2 (SD 7.7) with a mean length of stay of 11.6 (SD 18.3) days. The mortality rate was 1.8%. The results obtained in this study illustrate that trauma patients admitted to the emergency department at Eldoret are not assessed in a timely fashion, and the time frame recommendations postulated by RETTS are not adhered to. Assessment of patients according to the triage algorithm used revealed a significantly higher average Injury Severity Score in the red category than in the other color categories.
The results from this study clearly illustrate a lack of correct prioritization of patients in relation to the need for timely assessment. This is further demonstrated by the retrospective triage classification of patients, which identified patients with high ISS as in urgent need of care. Since no significant difference in to time to assessment regardless of injury severity was observed, the need for a well-functioning triage system is apparent.
改进创伤管理可缩短受伤与医疗干预之间的时间，从而降低发病率和死亡率。急诊科的分诊对于确保对受伤患者进行优先排序和及时评估至关重要。本研究的目的是调查缺乏正式分诊系统如何影响撒哈拉以南转诊医院的及时干预和死亡率。此外，该研究试图评估分诊对一个中等收入国家创伤患者有效管理的潜在益处。
进行了一项前瞻性描述性研究。纳入了在肯尼亚埃尔多雷特的莫伊教学与转诊医院8个月期间入住急诊科的成年创伤患者。记录了到达方式和生命体征参数。分析中包括的变量有损伤严重度评分、医生评估前的时间、住院时间和死亡率。根据患者记录，按照快速急诊分诊与治疗系统（RETTS）对患者进行回顾性分类。
共分析了571例患者，平均损伤严重度评分为12.2（标准差7.7），平均住院时间为11.6（标准差18.3）天。死亡率为1.8%。本研究获得的结果表明，入住埃尔多雷特急诊科的创伤患者未得到及时评估，且未遵循RETTS规定的时间框架建议。根据所使用的分诊算法对患者进行评估发现，红色类别患者的平均损伤严重度评分显著高于其他颜色类别。
本研究结果清楚地表明，在及时评估需求方面患者缺乏正确的优先排序。患者的回顾性分诊分类进一步证明了这一点，该分类确定高损伤严重度评分的患者急需护理。由于无论损伤严重程度如何，评估时间均无显著差异，因此显然需要一个运作良好的分诊系统。
