Maliziola Claudio, Frigerio Simona, Lanzarone Salvatore, Barale Alessandra, Berardino Maurizio, Clari Marco
AUSL Piacenza, Piacenza, Italy.
Città della Salute e della Scienza di Torino University Hospital, Turin, Italy.
Int Emerg Nurs. 2019 May;44:20-24. doi: 10.1016/j.ienj.2019.02.002. Epub 2019 Feb 26.
The trauma team (TT) model could reduce mortality, morbidity, and duration of hospital stay, costs, and complications. To avoid over- or undertriage for trauma team activation, robust criteria have to be chosen.
This study aimed to evaluate the sensitivity and specificity of a TT activation protocol for major trauma patients to predict the need for emergency treatment.
A retrospective observational study was carried out in the Emergency Department (ED) of a major Italian trauma center. Patients with trauma or burns who accessed the ED in 2015 with a triage red or yellow priority treatment code were included, while pediatric patients were excluded. Sensitivity, specificity and positive predictive values were calculated for each TT activation criteria and the aggregated criteria.
Data from 240 patients were collected: 40.42% of patients had a congruent triage while 50% were overtriaged and 9.58% undertriaged. A correct triage led to a lower hospital stay (p < 0.01), while undertriage was not associated with patients' death (p = 0.16). All criteria had a specificity higher than 95%, a total sensitivity of 80.83% and a total positive predictive value of 43.49%.
This study highlighted that the TT activation criteria had high specificity and sensitivity, while the positive predictive value of the criteria was lower. Mechanisms of injury criteria were less specific and sensitive in detecting the TT activation correctly. As nurses play a pivotal role in the triage of traumatized patients and the TT, reduction of under- and overtriage is essential to improve the patients' health outcome.
创伤团队（TT）模式可降低死亡率、发病率、缩短住院时间、降低成本并减少并发症。为避免创伤团队启动时的过度或不足分诊，必须选择可靠的标准。
本研究旨在评估针对严重创伤患者的TT启动方案预测紧急治疗需求的敏感性和特异性。
在意大利一家大型创伤中心的急诊科进行了一项回顾性观察研究。纳入2015年进入急诊科且分诊为红色或黄色优先治疗代码的创伤或烧伤患者，排除儿科患者。计算每个TT启动标准和综合标准的敏感性、特异性和阳性预测值。
收集了240例患者的数据：40.42%的患者分诊正确，50%过度分诊，9.58%分诊不足。正确分诊可缩短住院时间（p<0.01），而分诊不足与患者死亡无关（p=0.16）。所有标准的特异性均高于95%，总敏感性为80.83%，总阳性预测值为43.49%。
本研究强调TT启动标准具有较高的特异性和敏感性，而该标准的阳性预测值较低。损伤机制标准在正确检测TT启动方面特异性和敏感性较低。由于护士在创伤患者分诊和TT中起着关键作用，减少分诊不足和过度分诊对于改善患者健康结局至关重要。
