Division of Acute Care Surgery, LAC+USC Medical Center, University of Southern California, Los Angeles, CA, USA.
Division of Acute Care Surgery, Froedtert Hospital, Medical College of Wisconsin, Milwaukee, WI, USA.
Am Surg. 2023 Oct;89(10):4129-4134. doi: 10.1177/00031348231177939. Epub 2023 May 31.
The American College of Surgeons (ACS) delineates trauma team activation (TTA) criteria to identify seriously injured trauma patients in the field. Patients are deemed to be severely undertriaged (SU), placing them at risk for adverse outcomes, when they do not meet TTA criteria but nonetheless sustain significant injuries (Injury Severity Score [ISS] ≥25).
Delineate patient demographics, injuries, and outcomes after SU.
Trauma patients presenting to our ACS-verified Level 1 trauma center with ISS ≥25 were included (11/2015-03/2022). Transfers and private vehicle transports were excluded. Patients were dichotomized and compared by trauma arrival level: TTA (Appropriately Triaged, AT) vs routine consults (SU).
Study criteria were satisfied by 1653 patients: 1375 (83%) AT and 278 (17%) SU. Severely undertriaged patients were older than AT patients (47 vs 36 years, P < .001). Severely undertriaged occurred almost exclusively following blunt trauma (96% vs 71%, P < .001). Injury Severity Score was lower following SU than AT (29 vs 32, P < .001). The most common severe injuries (Abbreviated Injury Scale score [AIS] ≥3) among the SU group were in the Chest (n = 179, 64%). Severely undertriaged patients necessitated emergent intubation (n = 34, 12%), surgery (n = 59, 21%), and angioembolization (n = 22, 8%) at high rates. Severely undertriaged mortality was n = 40, 14%.
Severely undertriaged occurred among a substantial proportion of ISS ≥25 patients, predominately following blunt trauma. Severe chest injuries were most likely to evade capture. Rates of intubation, emergent intervention, and in-hospital mortality were high after SU. Efforts should be made to identify such patients in the field as they may benefit from TTA.
美国外科医师学院 (ACS) 制定了创伤救治团队激活 (TTA) 标准，以在现场识别严重受伤的创伤患者。如果患者不符合 TTA 标准，但仍遭受严重损伤（损伤严重程度评分 [ISS] ≥25），则认为他们被严重低分诊（SU），这使他们面临不良结局的风险。
描述 SU 后患者的人口统计学、损伤和结局。
本研究纳入了在我们经 ACS 认证的 1 级创伤中心就诊、ISS ≥25 的创伤患者（2015 年 11 月至 2022 年 3 月）。排除了转院和私人车辆转运的患者。根据创伤到达级别将患者分为两组并进行比较：TTA（适当分诊，AT）与常规会诊（SU）。
1653 名患者符合研究标准：1375 名（83%）为 AT，278 名（17%）为 SU。严重低分诊患者比 AT 患者年龄更大（47 岁比 36 岁，P <.001）。严重低分诊几乎完全发生在钝性创伤后（96%比 71%，P <.001）。SU 患者的损伤严重程度评分低于 AT（29 比 32，P <.001）。SU 组中最常见的严重损伤（损伤严重程度评分 [AIS] ≥3）为胸部损伤（179 例，64%）。严重低分诊患者需要紧急插管（n = 34，12%）、手术（n = 59，21%）和血管栓塞（n = 22，8%）的比例很高。严重低分诊患者的死亡率为 n = 40，14%。
ISS ≥25 的患者中，相当一部分存在严重低分诊，主要发生在钝性创伤后。严重的胸部损伤最有可能被遗漏。SU 后患者的插管、紧急干预和住院死亡率较高。应努力在现场识别此类患者，因为他们可能受益于 TTA。
