West J G, Murdock M A, Baldwin L C, Whalen E
J Trauma. 1986 Jul;26(7):655-9.
The primary goal of triage is to identify the majority of field trauma victims at risk for life-threatening injuries. When triage criteria are made sufficiently sensitive to accomplish this goal, high rates of overtriage occur. Orange County's original physiologic criteria were associated with an overtriage rate of 18-40% depending on the definition of a major trauma victim. During the first year's experience with the original physiologic criteria, 21% of non-CNS motor vehicle trauma deaths occurred in nondesignated hospitals. When the criteria were made more sensitive by adding non-time dependent triage criteria such as anatomic and mechanism of injury criteria, deaths in nondesignated hospitals dropped to 4.4%, but the rate of overtriage doubled. Despite this apparent high rate of overtriage, only 5.5% of all paramedic transports were for patients judged to have met field triage criteria. Based on this experience, an approach is suggested for evaluating the balance between over- and undertriage that occurs for a given set of triage criteria. Once this balance has been defined, triage guidelines can be modified to meet regional triage objectives.
分诊的主要目标是识别出大多数有生命危险损伤风险的现场创伤受害者。当分诊标准设定得足够敏感以实现这一目标时，就会出现高比例的过度分诊情况。根据重伤受害者的定义，奥兰治县最初的生理标准导致的过度分诊率为18% - 40%。在使用最初生理标准的第一年，21%的非中枢神经系统机动车创伤死亡发生在非指定医院。当通过添加诸如解剖学和损伤机制标准等非时间依赖性分诊标准使标准变得更加敏感时，非指定医院的死亡率降至4.4%，但过度分诊率翻了一番。尽管表面上过度分诊率很高，但所有护理人员运送的患者中只有5.5%是被判定符合现场分诊标准的。基于这一经验，建议采用一种方法来评估给定分诊标准下过度分诊和分诊不足之间的平衡。一旦确定了这种平衡，就可以修改分诊指南以满足区域分诊目标。
