From the Center for Policy and Research in Emergency Medicine (Maughan, Lin, Malveau, Griffiths, Newgard), Oregon Health & Science University, Portland, OR.
Department of Emergency Medicine, and Department of Obstetrics and Gynecology (Caughey), Oregon Health & Science University, Portland, OR.
J Am Coll Surg. 2022 Feb 1;234(2):139-154. doi: 10.1097/XCS.0000000000000025.
National guidelines for prehospital trauma triage aim to identify seriously injured patients who may benefit from transport to trauma centers. These guidelines have poor sensitivity for serious injury among older adults. We evaluated the cost-effectiveness of a high-sensitivity triage strategy for older adults.
We developed a Markov chain Monte Carlo microsimulation model to estimate the cost-effectiveness of high-sensitivity field triage criteria among older adults compared with current practice. The model used a retrospective cohort of 3621 community-dwelling Medicare beneficiaries who were transported by emergency medical services after an acute injury in 7 counties in the northwestern US during January to December 2011. These data informed model estimates of emergency medical services triage assessment, hospital transport patterns, and outcomes from index hospitalization up to 1 year after discharge. Outcomes beyond 1 year were modeled using published literature. Differences in cost and quality-adjusted life years (QALYs) were calculated for both strategies using a lifetime analytical horizon. We calculated the incremental cost-effectiveness ratio (cost per QALY gained) to assess cost-effectiveness, which we defined using a threshold of less than $100,000 per QALY.
High-sensitivity trauma field triage for older adults would produce a small incremental benefit in average trauma system effectiveness (0.0003 QALY) per patient at a cost of $1,236,295 per QALY. Sensitivity analysis indicates that the cost of initial hospitalization and emergency medical services adherence to triage status (ie transporting triage-positive patients to a trauma center) had the largest influence on overall cost-effectiveness.
High-sensitivity trauma field triage is not cost-effective among older adults.
院前创伤分诊的国家指南旨在识别可能受益于送往创伤中心的重伤患者。这些指南对老年人的严重损伤敏感性较差。我们评估了针对老年人的高敏感性分诊策略的成本效益。
我们开发了一个马尔可夫链蒙特卡罗微模拟模型，以估计与当前实践相比，老年人的高敏感性现场分诊标准的成本效益。该模型使用了来自美国西北部 7 个县的 3621 名在 2011 年 1 月至 12 月期间因急性损伤接受紧急医疗服务转运的社区居住的医疗保险受益人的回顾性队列。这些数据为模型对紧急医疗服务分诊评估、医院转运模式以及索引住院后的 1 年结果的估计提供了信息。1 年后的结果使用已发表的文献进行建模。使用终生分析时间范围计算了两种策略的成本和质量调整生命年（QALY）差异。我们计算了增量成本效益比（每获得一个 QALY 的成本）来评估成本效益，我们将其定义为每 QALY 低于 100,000 美元。
针对老年人的高敏感性创伤现场分诊将使每位患者的平均创伤系统效果略有增加（每患者 0.0003 QALY），每 QALY 的成本为 1,236,295 美元。敏感性分析表明，初始住院和紧急医疗服务对分诊状态的依从性（即转运分诊阳性患者到创伤中心）的成本对总体成本效益影响最大。
针对老年人的高敏感性创伤现场分诊不具有成本效益。
