| Autor: |
(Keitaro Yajima), 矢島 慶太郎, (Ryo Yamamoto), 山元 良, (Tomohiro Funabiki), 船曳 知弘, (Mitsuhide Kitano), 北野 光秀, (Junichi Sasaki), 佐々木 淳一 |
| Zdroj: |
Journal of Japanese Association for Acute Medicine; November 2021, Vol. 32 Issue: 11 p551-558, 8p |
| Abstrakt: |
【目的】重症外傷の病院前選別ではアンダートリアージの減少が予後改善に寄与するとされているが，本邦では病院前の重症外傷選定基準に関する研究は少ない。そこで，受傷機転と生理学的・解剖学的所見による複合的基準が重症外傷のアンダートリアージ減少に関連しているか検証した。【対象】2016年10月からの2年間に横浜市指定4区で発生した外傷患者を対象に，後ろ向き観察研究を行った。現場から搬送され入院あるいは外来死亡した症例の中で，来院時心肺停止を除外し解析を行った。研究期間前半はショックを伴う頸胸腹損傷・両側大腿骨骨折を重症外傷と判定し（基準A），後半は高リスク受傷機転および生理学的・解剖学的異常所見を複合的に用いて判定した（基準B）。基準を満たさず搬送され重症外傷と診断された症例をアンダートリアージとし，各基準のアンダートリアージ率を比較した。【結果】539例の対象症例のうち，基準A運用期間は281例，基準B運用期間は258例であった。年齢や重症度は両期間とも相似していたが，緊急手術は基準B運用期間で多かった。アンダートリアージ率は，基準Aで27.6%，基準Bで18.1%であり，基準Bで有意に低かった（p=0.04）。【結語】外傷患者の搬送プロトコールにおいて，受傷機転，生理学的所見，および解剖学的所見を複合的に用いた重症患者選別基準がアンダートリアージの減少につながることが示唆された。 Background: Prehospital protocols to identify severely injured patients to minimize undertriage would significantly improve outcomes of trauma patients. Given that literature on the validated prehospital triage in Japan is sparse, we assessed whether a protocol based on composite criteria involving injury mechanisms and anatomical/physiological signs would reduce undertriage in selected regions of Japan. Methods: We conducted a retrospective observational study involving trauma patients transported directly from the scene at four designated districts in Yokohama city and admitted to Saiseikai Yokohama–shi Tobu Hospital between 2016–2018. Patients arrived with cardiopulmonary arrest were excluded. In the first half of study period, prehospital triage (selection of severely injured patients) was conducted considering the existence of a predefined injury, trunk injury and/or bilateral femur fracture, with hemodynamic instability (protocol A), and in the latter half, based on injury mechanisms and anatomical/physiological signs (protocol B). Undertriage was determined when patients who did not meet severe–triage criteria were diagnosed as severely injured (ISS >15). The undertriage rates of the two prehospital protocols were compared. Results: A total of 539 patients were included in this study (281 were triaged following protocol A and 258 protocol B). Age and severity were similar between the two groups except for the need for urgent surgery, which was more frequent among patients triaged following protocol B. The undertriage rate was significantly lower among patients triaged following protocol B (27.6% vs. 18.1%, p=0.04). Conclusion: Incorporating injury mechanisms and physiological/anatomical signs to classify patients as severely injured during the prehospital triage protocol contributed to reducing undertriage. |
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