Hawkins M L, Treat R C, Mansberger A R
South Med J. 1987 May;80(5):562-5. doi: 10.1097/00007611-198705000-00005.
Trauma kills more Americans from age 1 to 34 than all diseases combined. Until recently, trauma care in the United States was delivered in a nonorganized, nonintegrated fashion, with trauma victims being transported to the medical facility closest to the scene of the accident. Many recent studies confirm an unacceptably high incidence--up to 75% in some studies--of preventable deaths in trauma victims treated under the nearest hospital system. This has resulted in the development of specialized trauma centers. The concept of a regional trauma center requires restrictive medical practice in which a limited number of hospitals and physicians provide care for those 5% to 12% of patients who are critically injured. The decision on whether to take a patient to the closest hospital or to the regional trauma center is a form of triage, with far-reaching consequences medically, ethically, and financially. Various triage instruments have been developed to try to identify those patients who would benefit from the resources of a trauma center, and to avoid overcrowding those centers with patients having less serious injuries. These triage tools are based on a combination of mechanism of injury, anatomic criteria, physiologic criteria, and co-morbidity factors.
1至34岁的美国人中，因创伤致死的人数超过了所有疾病致死人数的总和。直到最近，美国的创伤护理仍以无组织、不整合的方式进行，创伤受害者被送往离事故现场最近的医疗机构。最近的许多研究证实，在最近的医院系统治疗的创伤受害者中，可预防死亡的发生率高得令人无法接受——在某些研究中高达75%。这导致了专门创伤中心的发展。区域创伤中心的概念需要严格的医疗实践，即由数量有限的医院和医生为5%至12%的重伤患者提供护理。决定是将患者送往最近的医院还是区域创伤中心是一种分诊形式，在医学、伦理和经济方面都有着深远的影响。已经开发了各种分诊工具，试图识别那些将从创伤中心的资源中受益的患者，并避免让伤势较轻的患者挤满这些中心。这些分诊工具基于损伤机制、解剖学标准、生理学标准和合并症因素的综合考量。
