Fuller Gordon, Holt Chris, Keating Samuel, Turner Janette
University of Sheffield ORCID iD: https://orcid.org/0000-0001-8532-3500.
University of Sheffield.
Br Paramed J. 2024 Dec 1;9(3):28-36. doi: 10.29045/14784726.2024.12.9.3.28.
Triage tools are used within trauma networks to identify which injured patients should be bypassed and pre-alerted to major trauma centres. Despite the importance of treating the 'right patient in the right place at the right time', there has been no consensus on triage tool structure or content. This study aimed to identify, collate, review, summarise and recognise patterns across established major trauma triage tools.
UK and international triage tools used between 2012 and 2021 were identified through literature review and correspondence with trauma networks. A conceptual content analysis was then undertaken using an inductive codebook, comprising concepts of triage tool structure, intended population, inclusion criteria and included variables and thresholds. Thematic analysis was also performed to identify higher-level patterns within the data, with emerging patterns becoming categories for analysis. A narrative synthesis of findings was then undertaken.
In total, 53 major trauma tools were identified, comprising 19 UK tools and 35 published international tools. Most triage tools (n = 42/53, 80%) were developed by expert opinion, were paper based and shared a common structure of multiple domains, with constituent triage predictors assessed in parallel. A minority of tools were statistically derived prediction models, operationalised either as simple scores (n = 10, 19%) or as an electronic application (n = 1, 1%). Overall, 173 distinct triage variables were used, with the median number of constituent triage variables per triage tool being 19 (range 3-31). Four distinct patterns of triage tools were identified during thematic analysis, which differed in terms of format, number of triage variables, thresholds, scope for clinical judgement and relative diagnostic accuracy.
Many diverse major trauma triage tools were identified, with no consensus in format, structure or content. Quantification of constituent variables and identification of distinct categories of triage tools may guide the design of future triage tools.
创伤网络中使用分诊工具来确定哪些受伤患者应被分流，并提前通知主要创伤中心。尽管在“在正确的时间将正确的患者送到正确的地点”进行治疗很重要，但对于分诊工具的结构或内容尚未达成共识。本研究旨在识别、整理、回顾、总结并识别现有主要创伤分诊工具中的模式。
通过文献综述以及与创伤网络的通信，确定了2012年至2021年间使用的英国和国际分诊工具。然后使用归纳编码本进行概念性内容分析，该编码本包括分诊工具结构、目标人群、纳入标准以及所包含的变量和阈值等概念。还进行了主题分析，以识别数据中的更高层次模式，新出现的模式成为分析类别。随后对研究结果进行了叙述性综合。
总共识别出53种主要创伤工具，包括19种英国工具和35种已发表的国际工具。大多数分诊工具（n = 42/53，80%）是通过专家意见开发的，基于纸质，具有多个领域的共同结构，组成分诊预测指标并行评估。少数工具是基于统计得出的预测模型，以简单评分（n = 10，19%）或电子应用程序（n = 1，1%）的形式实施。总体而言，使用了173个不同的分诊变量，每个分诊工具的组成分诊变量中位数为19（范围3 - 31）。在主题分析过程中识别出四种不同的分诊工具模式，它们在形式、分诊变量数量、阈值、临床判断范围和相对诊断准确性方面存在差异。
识别出了许多不同的主要创伤分诊工具，在形式、结构或内容上没有达成共识。对组成变量的量化以及分诊工具不同类别的识别可能会指导未来分诊工具的设计。
