Undertriage of older trauma patients: is this a national phenomenon?
Undertriage of older trauma patients: is this a national phenomenon?
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DOI：
10.1016/j.jss.2015.05.017
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发表时间：
2015-11-01
影响因子：
2.2
通讯作者：
Haider, Adil H.
中科院分区：
文献类型：
--
作者：
Kodadek, Lisa M.;Selvarajah, Shalini;Haider, Adil H.
背景：年龄较大与受伤后的高发病率和死亡率相关。全州范围内的研究表明，年龄≥ 55岁的严重受伤患者通常被分流到较低级别的创伤中心（TC）或非创伤中心（NTCs）。本研究确定是否under triage is a national phenomenon.Materials and methods：使用2011年全国急诊科样本，显着受伤的患者年龄>= 55 y确定的诊断和新的损伤严重程度评分（NISS）>= 9。分类不足被定义为除I级或II级TC之外的任何地方的最终护理。加权描述性分析比较了按分诊状态分类的患者特征。多变量Logistic回归确定预测因素的分流，控制医院的特点，损伤的严重程度，和comorbidity.Results：4,152,541急诊科（艾德）访问满足纳入标准，74.0%的治疗在较低水平的TC或NTCs。I级和II级TC的患者NISS ≥ 9更常见（22.2%对12.3%，P < 0.001），但在所有NISS ≥ 9的患者中，61.3%的患者未被分诊到较低水平的TC或NTC。在多变量逻辑回归分析中，独立相关的因素是年龄增加、女性和跌倒相关损伤。亚组分析检查城市和郊区，只有在那里获得TC是更有可能的，并发现55.8%的患者的年龄undertriaged.Conclusions：有大量的undertriaged年龄>= 55岁的患者在全国范围内。一半以上严重受伤的老年患者没有在一级或二级治疗中心接受治疗。应确定分流不足的影响，以确保老年患者在最佳部位接受创伤护理。(C)2015爱思唯尔公司All rights reserved.
Background: Older age is associated with high rates of morbidity and mortality after injury. Statewide studies suggest significantly injured patients aged >= 55 y are commonly undertriaged to lower level trauma centers (TCs) or nontrauma centers (NTCs). This study determines whether undertriage is a national phenomenon.Materials and methods: Using the 2011 Nationwide Emergency Department Sample, significantly injured patients aged >= 55 y were identified by diagnosis and new injury severity score (NISS) >= 9. Undertriage was defined as definitive care anywhere other than level I or II TCs. Weighted descriptive analysis compared characteristics of patients by triage status. Multivariable logistic regression determined predictors of undertriage, controlling for hospital characteristics, injury severity, and comorbidities.Results: Of 4,152,541 emergency department (ED) visits meeting inclusion criteria, 74.0% were treated at lower level TCs or NTCs. Patients at level I and II TCs more commonly had NISS >= 9 (22.2% versus 12.3%, P < 0.001), but among all patients with NISS >= 9, 61.3% were undertriaged to a lower level TC or a NTC. On multivariable logistic regression, factors independently associated with higher odds of being undertriaged were increasing age, female gender, and fall-related injuries. A subgroup analysis examined urban and suburban areas only where access to a TC is more likely and found that 55.8% of patients' age were undertriaged.Conclusions: There is substantial undertriage of patients aged >= 55 y nationwide. Over half of significantly injured older patients are not treated at level I or II TCs. The impact of undertriage should be determined to ensure older patients receive trauma care at the optimal site. (C) 2015 Elsevier Inc. All rights reserved.