Assessing the Feasibility of the American College of Surgeons' Benchmarks for the Triage of Trauma Patients
Assessing the Feasibility of the American College of Surgeons' Benchmarks for the Triage of Trauma Patients
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DOI：
10.1001/archsurg.2011.43
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发表时间：
2011-07-01
影响因子：
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通讯作者：
Barnato, Amber E.
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文献类型：
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作者：
Mohan, Deepika;Rosengart, Matthew R.;Barnato, Amber E.
目的：通过描述最初被送往创伤中心的患者的转运模式，并估计如果完全实施的话，估计容量转移和挽救的潜在生命，以达到美国外科医师委员会关于创伤基准低于5%(在非创伤中心[NTCs]治疗中重度损伤的患者)和低于50%的超额(将轻伤患者转移到创伤中心[TCS])的可行性。设计、设置和患者：宾夕法尼亚州NTCS初步评估的成人创伤患者的回顾性队列研究(2001年4月1日至2005年3月31日)。我们使用了发表的与TCS治疗相关的死亡风险降低的估计。主要结果衡量标准：分流不足和分流过多的比率，估计的病人数量转移，以及挽救的生命数量。结果：2001-2005年间，宾夕法尼亚州NTCS总共对93 880名成人创伤患者进行了初步评估。分流不足占69%；分流过度占53%。要达到低于5%的分流不足，每年需要转移18945名患者，比目前的做法(每年3650次转移)增加了5倍。考虑到在TCS治疗的中重度创伤患者的绝对死亡风险降低了1.9%，这种做法的改变每年将挽救99人的潜在生命，或者每年需要191次转移才能挽救1人的潜在生命。结论：根据目前的实践模式，美国外科医师学会创伤委员会对创伤患者进行区域化的建议可能不可行。为了实现5%的分流不足，TCS必须将他们的能力提高5倍，NTCS的医生必须提高他们区分中、重度和其他伤害的能力，否则指南必须修改。
Objective: To test the feasibility of accomplishing the American College of Surgeons Committee on Trauma benchmarks of less than 5% undertriage (treatment of patients with moderate to severe injuries at nontrauma centers [NTCs]) and less than 50% overtriage (transfer of patients with minor injuries to trauma centers [TCs]) given current practice patterns by describing transfer patterns for patients taken initially to NTCs and estimating volume shifts and potential lives saved if full implementation were to occur.Design, Setting, and Patients: Retrospective cohort study of adult trauma patients initially evaluated at NTCs in Pennsylvania (between April 1, 2001, and March 31, 2005). We used published estimates of mortality risk reduction associated with treatment at TCs.Main Outcome Measures: Undertriage and overtriage rates, estimated patient volume shifts, and number of lives saved.Results: A total of 93 880 adult trauma patients were ini-tially evaluated at NTCs in Pennsylvania between 2001 and 2005. Undertriage was 69%; overtriage was 53%. Achieving less than 5% undertriage would require the transfer of 18 945 patients per year, a 5-fold increase from current practice (3650 transfers per year). Given an absolute mortality risk reduction of 1.9% for patients with moderate to severe injuries treated at TCs, this change in practice would save 99 potential lives per year or would require 191 transfers per year to save 1 potential life.Conclusions: Given current practice patterns, American College of Surgeons Committee on Trauma recommendations for the regionalization of trauma patients may not be feasible. To achieve 5% undertriage, TCs must increase their capacity 5-fold, physicians at NTCs must increase their capacity to discriminate between moderate to severe and other injuries, or the guidelines must be modified.