Norcross E D, Ford D W, Cooper M E, Zone-Smith L, Byrne T K, Yarbrough D R
Department of Surgery, Medical University of South Carolina, Charleston 29425, USA.
J Am Coll Surg. 1995 Dec;181(6):539-44.
The American College of Surgeons' Committee on Trauma (ACSCOT) has developed field triage guidelines intended to identify seriously injured patients. Unlike the 1990 version, the 1993 revision calls for on-line medical control assistance with the triage decision for patients whose only marker of severe injury is the mechanism of their injury. We prospectively examined the application of the 1990 ACSCOT field triage guidelines to evaluate Emergency Medical Service (EMS) utilization of these guidelines and the potential effects of the 1993 revision.
Emergency Medical Service personnel identified all ACSCOT criteria applicable to patients delivered to the level 1 trauma center at the Medical University of South Carolina. Trauma registry data were used to compare actual injury severity with applicable indicators. Patients with an injury severity score greater than or equal to 16 were considered seriously injured. The South Carolina state trauma and EMS databases were queried to estimate systemwide overtriage and undertriage rates.
Questionnaires were completed for 753 patients over 19 months of study. One hundred twenty-two patients had serious injuries. The estimated systemwide overtriage and undertriage rates were 2.7 and 20.3 percent, respectively. Physiologic criteria had a 64.8 percent sensitivity and a 41.8 percent positive predictive value (PPV). The addition of anatomic criteria increased sensitivity to 82.8 percent and decreased PPV to 26.9 percent. Adding mechanism of injury increased sensitivity to 95.1 percent but further reduced PPV to 18.2 percent. Review of EMS records suggests that the addition of on-line medical control for patients in whom only the mechanism of injury triage guidelines apply could improve PPV with little effect on sensitivity.
The current ACSCOT field triage guidelines are appropriate when applied by field EMS personnel.
美国外科医师学会创伤委员会（ACSCOT）制定了旨在识别重伤患者的现场分诊指南。与1990年版本不同，1993年修订版要求对于重伤唯一标志是受伤机制的患者，在分诊决策时提供在线医疗控制协助。我们前瞻性地研究了1990年ACSCOT现场分诊指南的应用情况，以评估紧急医疗服务（EMS）对这些指南的使用情况以及1993年修订版的潜在影响。
紧急医疗服务人员确定了所有适用于被送至南卡罗来纳医科大学一级创伤中心患者的ACSCOT标准。利用创伤登记数据将实际损伤严重程度与适用指标进行比较。损伤严重程度评分大于或等于16分的患者被视为重伤。查询南卡罗来纳州创伤和EMS数据库以估计全系统的过度分诊和分诊不足率。
在19个月的研究中，为753名患者完成了问卷调查。122名患者受重伤。估计全系统的过度分诊和分诊不足率分别为2.7%和20.3%。生理标准的敏感性为64.8%，阳性预测值（PPV）为41.8%。增加解剖学标准后，敏感性提高到82.8%，PPV降至26.9%。增加损伤机制后，敏感性提高到95.1%，但PPV进一步降至18.2%。对EMS记录的审查表明，对于仅适用损伤机制分诊指南的患者增加在线医疗控制，可能会提高PPV，而对敏感性影响不大。
现场EMS人员应用当前的ACSCOT现场分诊指南是合适的。
