Department of Neurosurgery, Walter Reed National Military Medical Center, Bethesda, Maryland.
Division of Spine Surgery, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland.
Neurosurgery. 2020 Mar 1;86(3):374-382. doi: 10.1093/neuros/nyz092.
Secondary overtriage is a problematic phenomenon because it creates unnecessary expense and potentially results in the mismanagement of healthcare resources. The rates of secondary overtriage among patients with complicated mild traumatic brain injury (cmTBI) are unknown.
To determine the rate of secondary overtriage among patients with cmTBI using the institutional trauma registry.
An observational study using retrospective analysis of 1447 hospitalizations including all consecutive patients with cmTBI between 2004 and 2013. Data on age, sex, race/ethnicity, insurance status, GCS, Injury Severity Score (ISS), Trauma Injury Severity Score, transfer mode, overall length of stay (LOS), LOS within intensive care unit, and total charges were collected and analyzed.
Overall, the rate of secondary overtriage among patients with cmTBI was 17.2%. These patients tended to be younger (median: 41 vs 60.5 yr; P < .001), have a lower ISS (9 vs 16; P < .001), and were more likely to be discharged home or leave against medical advice.
Our findings provide evidence to the growing body of literature suggesting that not all patients with cmTBI need to be transferred to a tertiary care center. In our study, these transfers ultimately incurred a total cost of $13 294 ($1337 transfer cost) per patient.
二次过度分诊是一个有问题的现象，因为它会产生不必要的费用，并可能导致医疗资源管理不当。目前尚不清楚复杂轻度创伤性脑损伤（cmTBI）患者的二次过度分诊率。
使用机构创伤登记处确定 cmTBI 患者的二次过度分诊率。
一项观察性研究，对 2004 年至 2013 年间连续收治的所有 cmTBI 患者进行回顾性分析，共纳入 1447 例住院患者。收集并分析患者的年龄、性别、种族/民族、保险状况、GCS、损伤严重程度评分（ISS）、创伤损伤严重程度评分、转院方式、总住院时间（LOS）、重症监护病房内 LOS 以及总费用。
总体而言，cmTBI 患者的二次过度分诊率为 17.2%。这些患者的年龄更小（中位数：41 岁 vs 60.5 岁；P<0.001），ISS 更低（9 分 vs 16 分；P<0.001），更有可能出院或未经医嘱离院。
我们的发现为越来越多的文献提供了证据，表明并非所有 cmTBI 患者都需要转至三级护理中心。在我们的研究中，这些转院最终使每位患者的总成本增加了 13294 美元（1337 美元的转院费用）。
