Geographic Disparities in Re-triage Destinations Among Seriously Injured Californians.
Geographic Disparities in Re-triage Destinations Among Seriously Injured Californians.
复制标题
重伤加州人重新分诊目的地的地理差异。
DOI：
10.1097/as9.0000000000000270
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发表时间：
2023
期刊：
影响因子：
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通讯作者：
Stey,AnneM
中科院分区：
文献类型：
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作者：
Furmanchuk,Al'ona;Rydland,KelseyJames;Hsia,ReneeY;Mackersie,Robert;Shi,Meilynn;Hauser,MarkWilliam;Kho,Abel;Bilimoria,KarlY;Stey,AnneM
目的：本研究的目的是量化加利福尼亚州重伤患者次优重新分诊的地理差异。背景数据摘要：重新分诊是指将重伤患者从非创伤和低级别创伤中心的急诊科紧急转移到高级创伤中心（理想情况下）。一些患者被重新分诊到第二个非创伤或低级别创伤中心（次优），而不是高级创伤中心（最佳）。方法：这是一项针对重伤患者的回顾性观察队列研究，定义为损伤严重程度评分> 15，在加利福尼亚州重新分诊（2009-2018）。考虑在向发送中心提交后 1 天内重新分类。州、地区创伤协调委员会 (RTCC)、当地紧急医疗服务机构和派遣中心层面对次优再分诊率进行了量化。广义线性混合效应回归量化了次优性与发送中心 RTCC 的关联。地理空间分析证明了次优再分类率的地理差异，并计算了替代再分类目的地。结果：对 8,882 名重伤患者进行了再分类，其中 2,680 名 (30.2%) 为次优。重新分诊不佳的患者转至第三家短期急症护理医院的几率增加 1.5 倍，出院后 60 天内重新入院的几率增加 1.25 倍。次优再分诊率从 2009 年的 29.3% 增加到 2018 年的 38.6%。然而，56.0% 的非创伤和低级别创伤中心至少有一次次优再分诊。西南 RTCC 在加州所有次优再分类中所占比例最大 (39.8%)。结论：人口密度高的地理区域经历了更高的次优再分类率。简介自 20 世纪 70 年代发展以来，创伤系统已降低了与伤害相关的死亡率。 1, 2 创伤系统协调每个步骤的护理，从紧急医疗服务 (EMS) 的院前现场分诊到创伤中心专业团队提供的明确护理。疾病控制和预防中心制定现场分诊指南是为了促进对重伤患者进行有效的 EMS 分诊，将其从现场直接送往高级创伤中心。 3 然而，17%–34% 的重伤患者仍未从现场分类到非创伤或低级别创伤中心。 4, 5 未分类的重伤患者在受伤后 48 小时内死亡的可能性增加 30%。 6 重新分诊是指将未分诊的重伤患者从非创伤或低级别创伤中心的急诊科 (ED) 紧急转移到高级别创伤中心。研究表明，那些在2小时内重新分诊的重伤患者的死亡率与直接到高级创伤中心进行现场分诊的患者的死亡率相当。 7, 8
Objective:The objective of this study is to quantify geographic disparities in suboptimal re-triage of seriously injured patients in California.Summary of background data:Re-triage is the emergent transfer of seriously injured patients from the emergency departments of nontrauma and low-level trauma centers to, ideally, high-level trauma centers. Some patients are re-triaged to a second nontrauma or low-level trauma center (suboptimal) instead of a high-level trauma center (optimal).Methods:This was a retrospective observational cohort study of seriously injured patients, defined by an Injury Severity Score> 15, re-triaged in California (2009–2018). Re-triages within 1 day of presentation to the sending center were considered. The suboptimal re-triage rate was quantified at the state, regional trauma coordinating committees (RTCC), local emergency medical service agencies, and sending center level. A generalized linear mixed-effects regression quantified the association of suboptimality with the RTCC of the sending center. Geospatial analyses demonstrated geographic variations in suboptimal re-triage rates and calculated alternative re-triage destinations.Results:There were 8,882 re-triages of seriously injured patients and 2,680 (30.2%) were suboptimal. Suboptimally re-triaged patients had 1.5 higher odds of transfer to a third short-term acute care hospital and 1.25 increased odds of re-admission within 60 days from discharge. The suboptimal re-triage rates increased from 29.3% in 2009 to 38.6% in 2018. However, 56.0% of nontrauma and low-level trauma centers had at least one suboptimal re-triage. The Southwest RTCC accounted for the largest proportion (39.8%) of all suboptimal re-triages in California.Conclusion:High population density geographic areas experienced higher suboptimal re-triage rates.INTRODUCTIONTrauma systems have decreased injury-associated mortality rates since their development in the 1970s. 1, 2 Trauma systems coordinate care at each step, from prehospital field triage by emergency medical services (EMS) to definitive care provided by specialized teams at trauma centers. The Centers for Disease Control and Prevention field triage guidelines were developed to promote efficient EMS triage of seriously injured patients from the field directly to high-level trauma centers. 3 Yet 17%–34% of seriously injured patients are still under-triaged from the field to nontrauma or low-level trauma centers. 4, 5 Seriously injured patients who are under-triaged have a 30% higher likelihood of mortality during the 48 hours after injury. 6 Re-triage is the emergent transfer of under-triaged, seriously injured patients from an emergency department (ED) of a nontrauma or low-level trauma center to a high-level trauma center. Studies have shown those seriously injured patients re-triaged within 2 hours have equivalent mortality to those who are field triaged directly to a high-level trauma center. 7, 8