Institute of Injury Prevention and Control, College of Public Health, Taipei Medical University, Taipei, Taiwan.
Section of Emergency Medicine, Department of Medicine, National Taiwan University Cancer Center, Taipei, Taiwan; Department of Emergency Medicine, National Taiwan University Hospital, Taipei, Taiwan.
Am J Emerg Med. 2024 Mar;77:147-153. doi: 10.1016/j.ajem.2023.12.011. Epub 2023 Dec 14.
Major trauma is a leading cause of unexpected death globally, with increasing age-adjusted death rates for unintentional injuries. Field triage schemes (FTSs) assist emergency medical technicians in identifying appropriate medical care facilities for patients. While full FTSs may improve sensitivity, step-by-step field triage is time-consuming. A simplified FTS (sFTS) that uses only physiological and anatomical criteria may offer a more rapid decision-making process. However, evidence for this approach is limited, and its performance in identifying all age groups requiring trauma center resources in Asia remains unclear.
We conducted a multinational retrospective cohort study involving adult trauma patients admitted to emergency departments in the included countries from 2016 to 2020. Prehospital and hospital data were reviewed from the Pan-Asia Trauma Outcomes Study database. Patients aged ≥18 years transported by emergency medical services were included. Patients lacking data regarding age, sex, physiological criteria, or injury severity scores were excluded. We examined the performance of sFTS in all age groups and fine-tuned physiological criteria to improve sFTS performance in identifying high-risk trauma patients in different age groups.
The sensitivity and specificity of the physiological and anatomical criteria for identifying major trauma (injury severity score ≥ 16) were 80.6% and 58.8%, respectively. The modified sFTS showed increased sensitivity and decreased specificity, with more pronounced changes in the young age group. Adding the shock index further increased sensitivity in both age groups.
sFTS using only physiological and anatomical criteria is suboptimal for Asian adult patients with trauma of all age groups. Adjusting the physiological criteria and adding a shock index as a triage tool can improve the sensitivity of severely injured patients, particularly in young age groups. A swift field triage process can maintain acceptable sensitivity and specificity in severely injured patients.
全球范围内，重大创伤是导致意外死亡的主要原因，且非故意受伤的年龄调整后死亡率呈上升趋势。现场分类方案（FTS）可帮助急救医疗技术员为患者确定合适的医疗保健机构。虽然完整的 FTS 可能会提高敏感性，但逐步的现场分类耗时较长。仅使用生理和解剖标准的简化 FTS（sFTS）可能提供更快速的决策过程。然而，这种方法的证据有限，其在确定亚洲所有年龄段需要创伤中心资源的能力尚不清楚。
我们进行了一项多国家回顾性队列研究，纳入了 2016 年至 2020 年期间纳入国家急诊部门收治的成年创伤患者。从泛亚洲创伤结局研究数据库中回顾了院前和医院数据。纳入年龄≥18 岁、由急救医疗服务转运的患者。排除缺乏年龄、性别、生理标准或损伤严重程度评分数据的患者。我们研究了 sFTS 在所有年龄段的表现，并对生理标准进行了微调，以提高 sFTS 在不同年龄段识别高危创伤患者的性能。
生理和解剖标准识别重大创伤（损伤严重程度评分≥16）的敏感性和特异性分别为 80.6%和 58.8%。改良的 sFTS 提高了敏感性，降低了特异性，年轻组的变化更为明显。在两个年龄组中，添加休克指数进一步提高了敏感性。
仅使用生理和解剖标准的 sFTS 对亚洲所有年龄段的成年创伤患者并不理想。调整生理标准并添加休克指数作为分类工具可以提高严重受伤患者的敏感性，特别是在年轻年龄组中。快速的现场分类过程可以在严重受伤患者中保持可接受的敏感性和特异性。
