Nilsbakken Inger Marie Waal, Wisborg Torben, Sollid Stephen, Jeppesen Elisabeth
Department of Research, Norwegian Air Ambulance Foundation, Postboks 414 Sentrum, 0103, Oslo, Norway.
Faculty of Health Sciences, University of Stavanger, Stavanger, Norway.
Scand J Trauma Resusc Emerg Med. 2025 May 12;33(1):83. doi: 10.1186/s13049-025-01387-2.
Dispatch priority assessments in emergency medical communication centres (EMCC) play a crucial role in determining how quickly emergency medical services reach the scene after an injury. Consequently, accurate prioritization of resources is important in ensuring that patients requiring specialized care receive timely treatment to optimize their outcome. Both dispatch under-triage, where patients with severe injuries receive low priority, and dispatch over-triage, which unnecessarily allocates limited emergency resources, can impact patient outcomes and system efficiency. This study aimed to assess dispatch priority in the EMCC for a cohort of trauma patients in Norway.
This registry-based study included 3633 patients from the Norwegian Trauma Registry and Oslo EMCC during 2019-2020. We assessed sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), false negative rate (dispatch under-triage rate), false positive rate (dispatch over-triage rate), and accuracy of dispatch priority. The New Injury Severity Score (NISS) > 15 was used as a reference standard. Differences in dispatch priority assessments were analysed using descriptive statistics. Two logistic regression models were used to examine the relationship between dispatch priority and factors associated with the assessment.
Our analysis revealed the following dispatch metrics: sensitivity (85%), specificity (11%), PPV (38%), NPV (53%), dispatch under-triage rate (15%), dispatch over-triage rate (89%), and overall accuracy (40%). Under-triaged dispatches frequently involved elderly trauma patients (53%) and patients with low-energy falls (51%). Elderly trauma patients had more than 7 times the odds of receiving inappropriately low dispatch priority compared to children and nearly twice the odds compared to adults, after accounting for factors such as injury mechanism. Similarly, female patients had 81% higher odds of receiving inappropriately low dispatch priority compared to male patients, when controlling for factors like age and injury mechanism. Among over-triaged dispatches, transport-related injuries accounted for half of the cases (50%).
This study primarily evaluated the national trauma system's dispatch priority criteria. Our findings indicate that elderly trauma patients, those with low-energy falls and female patients were often assigned inadequate priority by current criteria, indicating a need to reassess the current criteria to better address these patients' needs. Additionally, we found that patients involved in transport-related accidents were overrepresented among over-triaged dispatches, highlighting a potential misallocation of resources.
急诊医疗通信中心（EMCC）的调度优先级评估在确定受伤后紧急医疗服务到达现场的速度方面起着至关重要的作用。因此，准确分配资源对于确保需要特殊护理的患者及时接受治疗以优化其治疗结果非常重要。调度分诊不足（即重伤患者获得低优先级）和调度分诊过度（即不必要地分配有限的紧急资源）都会影响患者的治疗结果和系统效率。本研究旨在评估挪威一组创伤患者在EMCC中的调度优先级。
这项基于登记处的研究纳入了2019 - 2020年期间来自挪威创伤登记处和奥斯陆EMCC的3633名患者。我们评估了敏感性、特异性、阳性预测值（PPV）、阴性预测值（NPV）、假阴性率（调度分诊不足率）、假阳性率（调度分诊过度率）以及调度优先级的准确性。新损伤严重程度评分（NISS）>15被用作参考标准。使用描述性统计分析调度优先级评估的差异。使用两个逻辑回归模型来检验调度优先级与评估相关因素之间的关系。
我们的分析得出以下调度指标：敏感性（85%）、特异性（11%）、PPV（38%）、NPV（53%）、调度分诊不足率（15%）、调度分诊过度率（89%）以及总体准确性（40%）。分诊不足的调度经常涉及老年创伤患者（53%）和低能量跌倒患者（51%）。在考虑损伤机制等因素后，老年创伤患者获得不适当低调度优先级的几率是儿童的7倍多，是成年人的近两倍。同样，在控制年龄和损伤机制等因素后，女性患者获得不适当低调度优先级的几率比男性患者高81%。在分诊过度的调度中，与交通相关的损伤占病例的一半（50%）。
本研究主要评估了国家创伤系统的调度优先级标准。我们的研究结果表明，老年创伤患者、低能量跌倒患者和女性患者目前常常被现有标准赋予不适当的优先级，这表明需要重新评估当前标准以更好地满足这些患者的需求。此外，我们发现与交通相关事故的患者在分诊过度的调度中占比过高，凸显了资源的潜在分配不当。
