急诊医疗服务分诊（RETTS-p）的表现以及现场评估与医院最终诊断之间的一致性：一项针对16岁以下儿童的前瞻性观察研究。
The performance of the EMS triage (RETTS-p) and the agreement between the field assessment and final hospital diagnosis: a prospective observational study among children < 16 years.
作者信息
Magnusson Carl, Herlitz Johan, Karlsson Thomas, Jiménez-Herrera Maria, Axelsson Christer
机构信息
Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
Pre Hospen-Centre for Prehospital Research, Faculty of Caring Science, Work Life and Social Welfare, University of Borås, Borås, Sweden.
出版信息
BMC Pediatr. 2019 Dec 16;19(1):500. doi: 10.1186/s12887-019-1857-0.
BACKGROUND
The rapid triage and treatment system for paediatrics (RETTS-p) has been used by the emergency medical services (EMS) in the west of Sweden since 2014. The performance of the RETTS-p in the pre-hospital setting and the agreement between the EMS nurse's field assessment and the hospital diagnosis is unknown. The aim of this study was to evaluate the performance of the RETTS-p in the EMS and the agreement between the EMS field assessment and the hospital diagnosis.
METHODS
A prospective observational study was conducted among 454 patients < 16 years of age who were assessed and transported to the PED. Two instruments were used for comparison: 1) Classification of an emergent patient according to predefined criteria as compared to the RETTS-p and 2) Agreement between the EMS nurse's field assessment and the hospital diagnosis.
RESULTS
Among all children, 11% were identified as having vital signs associated with an increased risk of death and 7% were diagnosed in hospital with a potentially life-threatening condition. Of the children triaged with RETTS-p (85.9%), 149 of 390 children (38.2%) were triaged to RETTS-p red or orange (life-threatening, potentially life-threatening), of which 40 (26.8%) children were classified as emergent. The hospitalised children were triaged with the highest frequency to level yellow (can wait; 41.5%). In children with RETTS-p red or orange, the sensitivity for a defined emergent patient was 66.7%, with a corresponding specificity of 67.0%. The EMS field assessment was in agreement with the final hospital diagnosis in 80% of the cases.
CONCLUSIONS
The RETTS-p sensitivity in this study is considered moderate. Two thirds of the children triaged to life threatening or potentially life threatening were later identified as non-emergent. Of those, one in six was discharged from the PED without any intervention. Further, one third of the children were under triaged, the majority were found in the yellow triage level (can wait). The highest proportion of hospitalised patients was found in the yellow triage level. Our result is in agreement with previous studies using other triage instruments. A computerised decision support system might help the EMS triage to increase sensitivity and specificity.
背景
自2014年以来，瑞典西部的紧急医疗服务（EMS）一直在使用儿科快速分诊与治疗系统（RETTS-p）。RETTS-p在院前环境中的表现以及EMS护士的现场评估与医院诊断之间的一致性尚不清楚。本研究的目的是评估RETTS-p在EMS中的表现以及EMS现场评估与医院诊断之间的一致性。
方法
对454名16岁以下被评估并转运至儿科急诊部（PED）的患者进行了一项前瞻性观察研究。使用了两种工具进行比较：1）根据预定义标准将急诊患者分类并与RETTS-p进行比较；2）EMS护士的现场评估与医院诊断之间的一致性。
结果
在所有儿童中，11%被确定存在与死亡风险增加相关的生命体征，7%在医院被诊断为可能危及生命的疾病。在使用RETTS-p进行分诊的儿童中（85.9%），390名儿童中有149名（38.2%）被分诊为RETTS-p红色或橙色（危及生命、可能危及生命），其中40名（26.8%）儿童被分类为急诊。住院儿童被分诊到黄色等级（可等待）的频率最高（41.5%）。在RETTS-p红色或橙色的儿童中，对确定的急诊患者的敏感性为66.7%，相应的特异性为67.0%。在80%的病例中，EMS现场评估与最终医院诊断一致。
结论
本研究中RETTS-p的敏感性被认为是中等的。被分诊为危及生命或可能危及生命的儿童中有三分之二后来被确定为非急诊。其中，六分之一的儿童未经任何干预就从PED出院。此外，三分之一的儿童分诊不足，大多数处于黄色分诊等级（可等待）。住院患者中黄色分诊等级的比例最高。我们的结果与之前使用其他分诊工具的研究一致。计算机化决策支持系统可能有助于EMS分诊提高敏感性和特异性。
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