Neuroscience Research Australia, 139 Barker Street, Randwick, Sydney, NSW, 2031, Australia.
School of Medical Sciences, University of New South Wales, Sydney, NSW, 2031, Australia.
Scand J Trauma Resusc Emerg Med. 2019 Feb 13;27(1):18. doi: 10.1186/s13049-019-0593-7.
Prehospital undertriage occurs when the required level of care for a major trauma patient is underestimated and the patient is transported to a lower-level emergency care facility. One possible reason is that the pattern of injuries exceeding a certain severity threshold is not easily recognizable in the field. The present study aims to examine whether the injury patterns of major road trauma patients are associated with trauma centre transport decisions in Sweden, controlling for the distance from the crash to the nearest trauma centre and other patient characteristics.
The Swedish Traffic Accident Data Acquisition (STRADA) database was queried from April 2011 to March 2017. Teaching hospitals with neurosurgery capabilities were classified as trauma centres (TC), all other hospitals were classified as other emergency departments (ED). Injury Severity Score ≥ 13 was used as the threshold for major trauma. Ten common injury patterns were derived from the STRADA data; six patterns included serious neuro trauma to the head or spine. The remaining four patterns were: other severe injuries, moderate to serious abdomen injuries, serious thorax injuries and all other remaining injury patterns. Logistic regression was used to analyse the effect of injury patterns, age, sex and distance from crash to nearest TC on transport decision (TC or ED).
Of the 2542 patients, 38.0% were transported to a TC, equating to a prehospital undertriage of 62%. Over half (59.4%) of the patients had four or more Abbreviated Injury Scale (AIS) 2+ injuries. After controlling for age, sex and distance to nearest TC, only patients sustaining serious head injuries together with other severe injuries had significantly higher odds of being transported to a TC (OR = 4.18, 95% CI: 2.03, 8.73). The odds of being transported to a TC decreased by 5% with every kilometre further away the crash location was to the nearest TC.
These results highlight that there is considerable prehospital undertriage in Sweden and suggest that distance to nearest TC is more influential in transport decisions than injury pattern. These results can be used to further develop prehospital transportation guidelines and designation of trauma centres.
院前分诊不足是指对严重创伤患者的所需护理水平估计不足，导致患者被送往较低级别的急救护理机构。一个可能的原因是，在现场不易识别超过一定严重程度阈值的损伤模式。本研究旨在检验瑞典重大道路创伤患者的损伤模式是否与创伤中心转运决策相关，同时控制从事故现场到最近创伤中心的距离以及其他患者特征。
从 2011 年 4 月至 2017 年 3 月，对瑞典交通意外数据采集（STRADA）数据库进行了查询。具有神经外科能力的教学医院被归类为创伤中心（TC），所有其他医院被归类为其他急诊部（ED）。损伤严重程度评分≥13 被用作严重创伤的阈值。从 STRADA 数据中得出了 10 种常见的损伤模式；6 种模式包括头部或脊柱严重的神经创伤。其余 4 种模式为：其他严重损伤、中至严重腹部损伤、严重胸部损伤和所有其他剩余的损伤模式。Logistic 回归用于分析损伤模式、年龄、性别和从事故现场到最近 TC 的距离对转运决策（TC 或 ED）的影响。
在 2542 名患者中，38.0%被转运至 TC，相当于院前分诊不足 62%。超过一半（59.4%）的患者有 4 个或更多的损伤严重程度评分（AIS）2+损伤。在控制年龄、性别和到最近 TC 的距离后，只有同时发生严重头部损伤和其他严重损伤的患者被转运至 TC 的可能性显著更高（OR=4.18，95%CI：2.03，8.73）。随着事故现场到最近 TC 的距离每增加 1 公里，被转运至 TC 的可能性降低 5%。
这些结果突出表明瑞典存在相当大的院前分诊不足，并表明距离最近 TC 对转运决策的影响大于损伤模式。这些结果可用于进一步制定院前转运指南和创伤中心指定。
