Prehosp Emerg Care. 2021 Jan-Feb;25(1):95-102. doi: 10.1080/10903127.2020.1737281. Epub 2020 Mar 24.
To determine if the Mechanism of Injury Criteria of the Field Triage Decision Scheme (FTDS) are accurate for identifying children who need the resources of a trauma center.
EMS providers transporting any injured child ≤15 years, regardless of severity, to a pediatric trauma center in 3 midsized communities over 3 years were interviewed. Data collected through the interview included EMS observed physiologic condition, suspected anatomic injuries, and mechanism. Patients were then followed to determine if they needed the resources of a trauma center by reviewing their medical record after hospital discharge. Patients were considered to need a trauma center if they received an intervention included in a previously published consensus definition. Data were analyzed with descriptive statistics including positive likelihood ratios (+LR) and 95% confidence intervals (95%CI).
9,483 provider interviews were conducted and linked to hospital outcome data. Of those, 230 (2.4%) met the consensus definition for needing a trauma center. 1,572 enrolled patients were excluded from further analysis because they met the Physiologic or Anatomic Criteria of the FTDS. Of the remaining 7,911 cases, 62 met the consensus definition for needing a trauma center (TC). Taken as a whole, the Mechanism of Injury Criteria of the FTDS identified 14 of the remaining 62 children who needed the resources of a trauma center for a 77% under-triage rate. The mechanisms sustained were 36% fall (16 needed TC), 28% motor vehicle crash (MVC) (20 needed TC), 7% struck by a vehicle (10 needed TC), <1% motorcycle crash (none needed TC), and 29% had a mechanism not included in the FTDS (16 needed TC). Of those who sustained a mechanisms not listed in the FTDS, the most common mechanisms were sport related injuries not including falls (24% of 2,283 cases with a mechanism not included) and assault (13%). Among those who fell from a height greater than 10 feet, 4 needed a TC (+LR 5.9; 95%CI 2.8-12.6). Among those in a MVC, 41 were reported to have been ejected and none needed a TC, while 31 had reported meeting the intrusion criteria and 0 needed a TC. There were 32 reported as having a death in the same vehicle, and 2 needed a TC (+LR 7.42; 95%CI: 1.90-29.0).
Over a quarter of the children who needed the resources of a trauma center were not identified using the Physiologic or Anatomic Criteria of the Field Triage Decision Scheme. The Mechanism of Injury Criteria did not apply to over a quarter of the mechanisms experienced by children transported by EMS for injury. Use of the Mechanism Criteria did not greatly enhance identification of children who need a trauma center. More work is needed to improve the tool used to assist EMS providers in the identification of children who need the resources of a trauma center.
确定现场分诊决策方案（FTDS）的损伤机制标准是否能准确识别需要创伤中心资源的儿童。
在 3 年中，对从 3 个中等规模社区向儿科创伤中心转运的任何≤15 岁受伤儿童的 EMT 提供者进行访谈。通过访谈收集的数据包括 EMT 观察到的生理状况、疑似解剖损伤和损伤机制。然后通过查看出院后的病历来确定患者是否需要创伤中心的资源，以确定患者是否需要创伤中心。如果患者接受了之前发表的共识定义中包含的干预措施，则认为患者需要创伤中心。使用描述性统计（包括阳性似然比[+LR]和 95%置信区间[95%CI]）分析数据。
共进行了 9483 次提供者访谈，并与医院结果数据相关联。其中，230 例（2.4%）符合需要创伤中心的共识定义。由于 FTDS 的生理或解剖标准，有 1572 名入组患者被排除在进一步分析之外。在剩余的 7911 例中，有 62 例符合需要创伤中心的共识定义（TC）。总的来说，FTDS 的损伤机制标准识别出了其余 62 名需要创伤中心资源的儿童中的 14 名，分诊不足率为 77%。受伤机制为 36%坠落伤（16 例需要 TC）、28%机动车碰撞（MVC）（20 例需要 TC）、7%被车辆撞击（10 例需要 TC）、<1%摩托车碰撞（无需要 TC）和 29%机制未包含在 FTDS 中（16 例需要 TC）。在未包含在 FTDS 中的机制中，最常见的机制是与运动相关的非坠落伤（24%未包含的 2283 例机制）和袭击（13%）。在从 10 英尺以上高处坠落的儿童中，有 4 名需要 TC（+LR 5.9；95%CI 2.8-12.6）。在 MVC 中，有 41 名儿童报告被抛出，而无一人需要 TC，而有 31 名儿童报告符合侵入标准，而无一人需要 TC。有 32 名儿童报告在同一车辆中死亡，有 2 名需要 TC（+LR 7.42；95%CI：1.90-29.0）。
使用现场分诊决策方案的生理或解剖标准，无法识别超过四分之一需要创伤中心资源的儿童。损伤机制标准不适用于超过四分之一接受 EMT 转运以治疗损伤的儿童的机制。使用机制标准并不能大大提高识别需要创伤中心的儿童的能力。需要进一步努力改进用于协助 EMT 提供者识别需要创伤中心资源的儿童的工具。
