Traisathit Patrinee, Chittawatanarat Kaweesak, Chandacham Kamtone, Srikummoon Pimwarat, Kittikhunakon Areerat, Nontapa Chalermrat, Chotirosniramit Narain
Department of Statistics, Faculty of Science, Chiang Mai University, Chiang Mai, Thailand.
Department of Surgery, Faculty of Medicine, Chiang Mai University, 110 Intawarorose road, Chiang Mai, Chiang Mai, 50200, Thailand.
BMC Emerg Med. 2025 Apr 17;25(1):64. doi: 10.1186/s12873-025-01220-0.
Overcrowding in emergency departments (EDs) due to injured patients who do not need urgent treatment can lead to less efficacious healthcare outcomes for those that do. The trauma referral audit (TRA) was developed to support medical staff and ensure that the injured receive treatment timely and efficiently.
Data on 14,399 injured patients referred to Maharaj Nakorn Chiang Mai Hospital between 2007 and 2017 were analyzed to examine the impact of the full TRA program implemented at the end of 2010. Injury severity was measured by using the injury severity score (ISS) whereby a score > 9 points infers severe injury. The impact of the establishment of TRA was examined using the trend of referrals and an interrupted time-series analysis of monthly mortality among patients with severe injury.
The median ISS of the patients in 2010 was 9 [4-18] and slightly increased to the highest score of 16 [8-25] in 2017. The proportion of patients with less severe injuries (ISS ≤ 9) decreased after the full implementation of TRA (55.4% in 2010 compared to 42.3% in 2017). Overall mortality was 6% (5.5% vs. 6.2% for the pre- and post-full TRA periods, respectively), and the mortality rate tended to increase from 4.77% in 2011 to 7.59 in 2017. The monthly mortality rate was estimated at 7.22% [95% confidence interval (CI) = 5.89-8.56%] with a significant increase of mortality in the post-full TRA period by 1.57% [0.16-2.98%] and in the annual trend of 0.11% [0.05-0.16%]. However, when considering severely injured patients only, the level and trend of the mortality rate were no different.
Although the TRA program could help reduce patient overcrowding in EDs, it does not reduce the risk of mortality. Revision of the referral and in-hospital care guidelines accounting for these relevant factors might lead to a decrease in mortality.
Clinical trial number: Not applicable.
急诊科因无需紧急治疗的受伤患者导致的过度拥挤，可能会使真正需要紧急治疗的患者获得的医疗效果降低。创伤转诊审核（TRA）旨在为医务人员提供支持，确保受伤患者得到及时有效的治疗。
分析了2007年至2017年间转诊至清迈玛哈叻医院的14399名受伤患者的数据，以研究2010年底实施的全面TRA计划的影响。使用损伤严重程度评分（ISS）来衡量损伤严重程度，得分>9分表示重伤。通过转诊趋势和重伤患者月度死亡率的中断时间序列分析，研究了TRA设立的影响。
2010年患者的ISS中位数为9[4-18]，2017年略有上升至最高值16[8-25]。全面实施TRA后，轻伤患者（ISS≤9）的比例下降（2010年为55.4%，2017年为42.3%）。总体死亡率为6%（全面TRA实施前和后分别为5.5%和6.2%），死亡率从2011年的4.77%趋于上升至2017年的7.59%。月度死亡率估计为7.22%[95%置信区间（CI）=5.89-8.56%]，全面TRA实施后死亡率显著增加1.57%[0.16-2.98%]，年度趋势为0.11%[0.05-0.16%]。然而，仅考虑重伤患者时，死亡率水平和趋势并无差异。
尽管TRA计划有助于减少急诊科的患者过度拥挤，但并未降低死亡风险。修订考虑这些相关因素的转诊和院内护理指南可能会降低死亡率。
临床试验编号：不适用。
