Roorda J, van Beeck E F, Stapert J W, ten Wolde W
Community Health Service Regio Twente, Enschede, Rotterdam, Netherlands.
Injury. 1996 Apr;27(3):163-7. doi: 10.1016/0020-1383(95)00218-9.
In this study, we have evaluated the performance of the Revised Trauma Score (RTS) as a triage instrument in the prehospital setting in The Netherlands. To this end we analysed prehospital and clinical data on 398 injured patients in an urban-rural area in the east of the Netherlands. Our study included injured patients aged over 15 who were alive at the time the ambulance arrived. We found a comparatively low prevalence of major injuries in the prehospital setting, which varied with the definition used (for patients with an HTI-ISS > or = 18, it was 5.8 per cent, for HTI-ISS > or = 20 it was 3.7 per cent; for a modified HTI-ISS criterion it was 5.3 per cent and 2.7 per cent needed major emergency therapy). Estimates of sensitivity were also rather low and varied with the definition used (38 per cent for HTI-ISS > or = 18; 56 per cent for HTI-ISS > or = 20, 45 per cent for the modified HTI-ISS criterion and 76 per cent for major emergency treatment). The specificity and the predictive value of a lowered RTS, however, were 94 per cent and 26 per cent respectively for all definitions used. The conclusion of this study is that the performance of the RTS in this study population is poorer than expected from earlier studies. The low prevalence of major injuries in the prehospital setting in The Netherlands and the distribution of case severity may possibly explain these results.
在本研究中，我们评估了修订创伤评分（RTS）作为荷兰院前分诊工具的性能。为此，我们分析了荷兰东部城乡地区398名受伤患者的院前和临床数据。我们的研究纳入了15岁以上且在救护车到达时仍存活的受伤患者。我们发现院前环境中重伤的患病率相对较低，其因所使用的定义而异（对于HTI-ISS≥18的患者，为5.8%；对于HTI-ISS≥20的患者，为3.7%；对于改良的HTI-ISS标准，为5.3%，需要进行重大紧急治疗的为2.7%）。敏感性估计值也相当低，且因所使用的定义而异（HTI-ISS≥18时为38%；HTI-ISS≥20时为56%，改良的HTI-ISS标准时为45%，重大紧急治疗时为76%）。然而，对于所有使用的定义，降低的RTS的特异性和预测值分别为94%和26%。本研究的结论是，RTS在该研究人群中的表现比早期研究预期的要差。荷兰院前环境中重伤的低患病率以及病例严重程度的分布可能解释了这些结果。
