Morris J A, Auerbach P S, Marshall G A, Bluth R F, Johnson L G, Trunkey D D
JAMA. 1986 Sep 12;256(10):1319-25.
Implementation of a regional trauma care system requires a field triage tool that identifies the severely injured patient and transports him to a trauma center, while preserving the flow of minimally injured patients to community hospitals. We prospectively tested the Trauma Score (TS) as a field triage tool and evaluated its accuracy against that of the Injury Severity Score (ISS), calculated after the patients' injuries were fully defined. During an 18-month period, 1106 patients admitted to the trauma center at San Francisco General Hospital had a TS determined in the field (TS1) and on arrival at the emergency department. A TS1 of 14 or less defined a subgroup of 222 patients in whom 93% of the deaths occurred. Using an ISS of 20 or more as an indicator of life-threatening injury, we determined the predictive value of TS1. There were 66 false-negatives (ISS, greater than or equal to 20; TS1, 15 or 16) and 107 false-positives (ISS, less than 20; TS1, less than or equal to 14). Using a prehospital TS of 14 or less as an indicator of serious injury, only 20% of a major urban trauma population would qualify for diversion to a trauma center.
实施区域创伤护理系统需要一种现场分诊工具，该工具能够识别重伤患者并将其转运至创伤中心，同时确保轻伤患者能够顺畅地流向社区医院。我们前瞻性地测试了创伤评分（TS）作为现场分诊工具，并将其准确性与损伤严重程度评分（ISS）进行了对比，ISS是在患者损伤情况完全明确后计算得出的。在18个月的时间里，1106名入住旧金山综合医院创伤中心的患者在现场（TS1）和抵达急诊科时都进行了TS测定。TS1为14或更低定义了一个222名患者的亚组，其中93%的死亡病例发生在该亚组中。以ISS为20或更高作为危及生命损伤的指标，我们确定了TS1的预测价值。有66例假阴性（ISS大于或等于20；TS1为15或16）和107例假阳性（ISS小于20；TS1小于或等于14）。将院前TS为14或更低作为重伤的指标，只有20%的主要城市创伤人群有资格被分流至创伤中心。
