Simmons E, Hedges J R, Irwin L, Maassberg W, Kirkwood H A
Oregon Health Division, Oregon Health Sciences University, Portland, USA.
Ann Emerg Med. 1995 Oct;26(4):461-8. doi: 10.1016/s0196-0644(95)70115-x.
To compare information contained in standard out-of-hospital trauma triage criteria and standard criteria plus advanced emergency medical technician (EMT) injury severity perception for determination of patient need for trauma center evaluation.
Prospective, observational cohort analysis of trauma triage by advanced EMTs.
Out-of-hospital, geographically stratified statewide sample of patients injured in Oregon.
Advanced EMTs provided patient information on demographics, physiologic parameters, injury anatomy and mechanism, premorbid conditions, EMT injury severity perception, and trauma system entry status. A four-point scale was used to grade the injury severity perception. Need for trauma center evaluation was defined as major surgery within 6 hours of hospital arrival, admission to the ICU, death in the hospital, or Injury Severity Scale score of 16 or more. The relative triage information gain with injury severity perception was assessed by use of logistic regression, tree-based models, and receiver operating characteristic (ROC) curves. Of 1,063 patients, 307 (28.9%) warranted trauma center evaluation. With logistic regression modeling, the following standard triage parameters were associated (P < .05) with the need for trauma center evaluation after inclusion of injury severity perception: systolic blood pressure less than 90 mm Hg, abnormal respiratory rate (less than 10 or more than 29), Glasgow Coma Scale score less than 13, penetrating injury (midthigh to head), two or more obvious proximal long-bone fractures, and fall of more than 20 feet. The two largest injury severity perception categories had the greatest odds ratios (20:1 and 167:1). ROC curve areas improved with injury severity perception (.88 versus .83 without; P < .0001).
Standard out-of-hospital triage criteria benefit from inclusion of advanced EMT injury severity perception information.
比较标准院外创伤分诊标准以及标准标准加高级急救医疗技术员（EMT）损伤严重程度感知所包含的信息，以确定患者是否需要进行创伤中心评估。
对高级急救医疗技术员进行的创伤分诊进行前瞻性观察队列分析。
俄勒冈州全州范围内按地理分层的院外受伤患者样本。
高级急救医疗技术员提供了有关患者人口统计学、生理参数、损伤解剖结构和机制、病前状况、急救医疗技术员损伤严重程度感知以及创伤系统进入状态的信息。使用四点量表对损伤严重程度感知进行分级。创伤中心评估的需求定义为入院后6小时内进行大手术、入住重症监护病房、在医院死亡或损伤严重程度评分达到16分或更高。通过使用逻辑回归、基于树的模型和受试者工作特征（ROC）曲线来评估损伤严重程度感知带来的相对分诊信息增益。在1063名患者中，307名（28.9%）需要进行创伤中心评估。通过逻辑回归建模，在纳入损伤严重程度感知后，以下标准分诊参数与创伤中心评估需求相关（P < .05）：收缩压低于90毫米汞柱、呼吸频率异常（低于10或高于29）、格拉斯哥昏迷量表评分低于13、穿透性损伤（大腿中部至头部）、两根或更多明显的近端长骨骨折以及坠落超过20英尺。损伤严重程度感知的两个最大类别具有最高的优势比（20:1和167:1）。ROC曲线面积因损伤严重程度感知而有所改善（有损伤严重程度感知时为.88，无损伤严重程度感知时为.83；P < .000）。
标准院外分诊标准因纳入高级急救医疗技术员损伤严重程度感知信息而受益。
