Department of Surgery, University of North Carolina at Chapel Hill, 4008 Burnett Womack Building, CB 7228, Chapel Hill, NC, 27599, USA.
Department of Surgery, University of Washington Harborview Medical Center, 325 Ninth Ave, Box 359796, Seattle, WA, USA.
World J Surg. 2020 Jun;44(6):1727-1735. doi: 10.1007/s00268-020-05426-0.
Secondary overtriage (OT) is the unnecessary transfer of injured patients between facilities. In low- and middle-income countries (LMICs), which shoulder the greatest burden of trauma globally, the impact of wasted resources on an overburdened system is high. This study determined the rate and associated characteristics of OT at a Malawian central hospital.
A retrospective analysis of prospectively collected data from January 2012 through July 2017 was performed at Kamuzu Central Hospital (KCH) in Lilongwe, Malawi. Patients were considered OT if they were discharged alive within 48 h without undergoing a procedure, and were not severely injured or in shock on arrival. Factors evaluated for association with OT included patient demographics, injury characteristics, and transferring facility information.
Of 80,915 KCH trauma patients, 15,422 (19.1%) transferred from another facility. Of these, 8703 (56.2%) were OT. OT patients were younger (median 15, IQR: 6-31 versus median 26, IQR: 11-38, p < 0.001). Patients with primary extremity injury (5308, 59.9%) were overtriaged more than those with head injury (1991, 51.8%) or torso trauma (1349, 50.8%), p < 0.001. The OT rate was lower at night (18.9% v 28.7%, p < 0.001) and similar on weekends (20.4% v 21.8%, p = 0.03). OT was highest for penetrating wounds, bites, and falls; burns were the lowest. In multivariable modeling, risk of OT was greatest for burns and soft tissue injuries.
The majority of trauma patients who transfer to KCH are overtriaged. Implementation of transfer criteria, trauma protocols, and interhospital communication can mitigate the strain of OT in resource-limited settings.
二次过转（OT）是指在医疗机构之间不必要地转移受伤患者。在全球创伤负担最大的低收入和中等收入国家（LMICs），浪费资源对负担过重的系统的影响是巨大的。本研究旨在确定马拉维一家中央医院的 OT 发生率及其相关特征。
对 2012 年 1 月至 2017 年 7 月期间前瞻性收集的数据进行回顾性分析，地点在马拉维利隆圭的卡姆祖中央医院（KCH）。如果患者 Alive 出院，且在 48 小时内没有接受任何治疗，且在入院时没有严重受伤或休克，则认为患者为 OT。评估与 OT 相关的因素包括患者人口统计学特征、损伤特征和转诊机构信息。
在 KCH 的 80915 例创伤患者中，有 15422 例（19.1%）从其他机构转入。其中，8703 例（56.2%）为 OT。OT 患者年龄更小（中位数 15 岁，IQR：6-31 岁比中位数 26 岁，IQR：11-38 岁，p<0.001）。与头部损伤（1991 例，51.8%）或躯干损伤（1349 例，50.8%）相比，初次肢体损伤（5308 例，59.9%）患者的 OT 发生率更高（p<0.001）。夜间 OT 率（18.9%比 28.7%，p<0.001）较低，周末（20.4%比 21.8%，p=0.03）相似。OT 发生率最高的是穿透伤、咬伤和跌倒；烧伤最低。多变量模型中，OT 风险最高的是烧伤和软组织损伤。
转入 KCH 的大多数创伤患者都被过度转诊。在资源有限的情况下，实施转诊标准、创伤方案和医院间的沟通可以减轻 OT 的压力。
