成熟创伤体系中儿科创伤中心分诊不足的分析。
An analysis of pediatric trauma center undertriage in a mature trauma system.
机构信息
From the General Surgery Residency, University of Louisville, Louisville, Kentucky (A.T.R.); Trauma and Acute Care Surgery, Penn Medicine Lancaster General Health, Lancaster, Pennsylvania (M.A.H., T.M.V., E.H.B., S.J., F.B.R.); and Department of Surgery (B.A.G.), UPMC Children's Hospital of Pittsburg, Pittsburg, Pennsylvania, Trauma Research Program (A.D.C.), Chandler Regional Medical Center, Chandler, Arizona.
出版信息
J Trauma Acute Care Surg. 2019 Oct;87(4):800-807. doi: 10.1097/TA.0000000000002265.
BACKGROUND
Improved mortality as a result of appropriate triage has been well established in adult trauma and may be generalizable to the pediatric trauma population as well. We sought to determine the overall undertriage rate (UTR) in the pediatric trauma population within Pennsylvania (PA). We hypothesized that a significant portion of pediatric trauma population would be undertriaged.
METHODS
All pediatric (age younger than 15) admissions meeting trauma criteria (International Classification of Diseases, Ninth Revision: 800-959) from 2003 to 2015 were extracted from the Pennsylvania Health Care Cost Containment Council (PHC4) database and the Pennsylvania Trauma Systems Foundation (PTSF) registry. Undertriage was defined as patients not admitted to PTSF-verified pediatric trauma centers (n = 6). The PHC4 contains inpatient admissions within PA, while PTSF only reports admissions to PA trauma centers. ArcGIS Desktop was used for geospatial mapping of undertriage.
RESULTS
A total of 37,607 cases in PTSF and 63,954 cases in PHC4 met criteria, suggesting UTR of 45.8% across PA. Geospatial mapping reveals significant clusters of undertriage regions with high UTR in the eastern half of the state compared to low UTR in the western half. High UTR seems to be centered around nonpediatric facilities. The UTR for patients with a probability of death 1% or less was 39.2%.
CONCLUSION
Undertriage is clustered in eastern PA, with most areas of high undertriage located around existing trauma centers in high-density population areas. This pattern may suggest pediatric undertriage is related to a system issue as opposed to inadequate access.
LEVEL OF EVIDENCE
Retrospective study, without negative criteria, Level III.
背景
适当分诊可显著提高成人创伤患者的生存率，这一点已得到充分证实，其可能同样适用于儿科创伤患者。我们旨在确定宾夕法尼亚州（PA）儿科创伤患者的总体分诊不足率（UTR）。我们假设，相当一部分儿科创伤患者可能会分诊不足。
方法
从 2003 年至 2015 年，从宾夕法尼亚州医疗保健成本控制委员会（PHC4）数据库和宾夕法尼亚州创伤系统基金会（PTSF）登记处提取符合创伤标准（国际疾病分类，第 9 版：800-959）的所有儿科（年龄小于 15 岁）入院患者。分诊不足定义为未收治到 PTSF 认证的儿科创伤中心的患者（n=6）。PHC4 包含宾夕法尼亚州内的住院患者，而 PTSF 仅报告宾夕法尼亚州创伤中心的入院患者。ArcGIS 桌面用于分诊不足的地理空间映射。
结果
在 PTSF 中有 37607 例，在 PHC4 中有 63954 例符合标准，表明整个宾夕法尼亚州的 UTR 为 45.8%。地理空间映射显示，分诊不足的高 UTR 区域集中在该州的东部，而西部 UTR 较低。高 UTR 似乎集中在非儿科医疗机构周围。死亡率为 1%或更低的患者的 UTR 为 39.2%。
结论
分诊不足在宾夕法尼亚州东部呈聚集性，大多数高分诊不足区域位于人口密集地区的现有创伤中心周围。这种模式可能表明儿科分诊不足与系统问题有关，而不是与获取途径不足有关。
证据水平
无阴性标准的回顾性研究，III 级。
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