Accuracy of Prehospital Triage in Selecting Severely Injured Trauma Patients
| Autor: | Luke P. H. Leenen, Rogier van der Sluijs, Marcel G. W. Dijkgraaf, Frank J. Voskens, Mark van Heijl, Egbert J M M Verleisdonk, Ger D. J. van Olden, Roderick M. Houwert, Michiel Jm Segers, Eveline A. J. van Rein, Robert Anton Lichtveld |
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| Přispěvatelé: | APH - Methodology, Clinical Research Unit |
| Jazyk: | angličtina |
| Rok vydání: | 2018 |
| Předmět: |
Adult
Male medicine.medical_specialty Emergency Medical Services MEDLINE 03 medical and health sciences 0302 clinical medicine Injury Severity Score Trauma Centers Emergency medical services Medicine Humans 030212 general & internal medicine Prospective Studies Prospective cohort study Prehospital triage Quality of Health Care business.industry Patient Selection Trauma center Field triage 030208 emergency & critical care medicine Middle Aged medicine.disease Triage Transportation of Patients Emergency medicine Practice Guidelines as Topic Wounds and Injuries Surgery Female Medical emergency Guideline Adherence business |
| Zdroj: | JAMA surgery, 153(4), 322-327. American Medical Association |
| ISSN: | 2168-6262 |
| Popis: | Importance A major component of trauma care is adequate prehospital triage. To optimize the prehospital triage system, it is essential to gain insight in the quality of prehospital triage of the entire trauma system. Objective To prospectively evaluate the quality of the field triage system to identify severely injured adult trauma patients. Design, Setting, and Participants Prehospital and hospital data of all adult trauma patients during 2012 to 2014 transported with the highest priority by emergency medical services professionals to 10 hospitals in Central Netherlands were prospectively collected. Prehospital data collected by the emergency medical services professionals were matched to hospital data collected in the trauma registry. An Injury Severity Score of 16 or more was used to determine severe injury. Main Outcomes and Measures The quality and diagnostic accuracy of the field triage protocol and compliance of emergency medical services professionals to the protocol. Results A total of 4950 trauma patients were evaluated of which 436 (8.8%) patients were severely injured. The undertriage rate based on actual destination facility was 21.6% (95% CI, 18.0-25.7) with an overtriage rate of 30.6% (95% CI, 29.3-32.0). Analysis of the protocol itself, regardless of destination facility, resulted in an undertriage of 63.8% (95% CI, 59.2-68.1) and overtriage of 7.4% (95% CI, 6.7-8.2). The compliance to the field triage trauma protocol was 73% for patients with a level 1 indication. Conclusions and Relevance More than 20% of the patients with severe injuries were not transported to a level I trauma center. These patients are at risk for preventable morbidity and mortality. This finding indicates the need for improvement of the prehospital triage protocol. |
| Databáze: | OpenAIRE |
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