Prospective Validation and Cost Analysis of the National Guidelines for Field Tri

国家田间试验指南的前瞻性验证和成本分析

• 批准号: 8137865
• 负责人: Craig D. Newgard
• 金额: $ 29.87万
• 依托单位: OREGON HEALTH & SCIENCE UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2010
• 资助国家: 美国
• 起止时间: 2010-09-01 至 2013-08-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8137865
• 关键词: Prospective; Validation; Cost; Analysis; National

DESCRIPTION (provided by applicant): Proposed Approach: Out-of-hospital trauma triage is a critical component of trauma systems and the primary mechanism for concentrating seriously injured patients in major trauma centers, yet the triage guidelines have never been rigorously validated or subject to formal cost analysis. In this project, we will use a prospective, population-based, out-of-hospital injury cohort of children, adults, and elders to examine the accuracy and cost implications of the field triage guidelines, plus opportunities for improving the triage algorithm. Importance: Data-driven solutions to increase trauma system efficiency, reduce costs, and preserve valuable resources, while still maximizing injury outcomes are desperately needed. Results from this study could have substantive implications for improving the cost-effective regionalization of seriously injured patients. Objectives: The overall goals of this application are to generate unbiased age-specific estimates of decision scheme accuracy (sensitivity and specificity) among a broad, representative injury population and to closely evaluate the cost implications of field triage. Our hypothesis is that the triage guidelines have higher under- and over-triage rates than previously recognized, that triage is heavily influenced by EMS provider judgment, and that there are significant cost implications associated with mis-triage. This proposal has 3 specific aims: Specific Aim 1. Prospectively validate the field triage decision scheme among children, adults, and elders in 2 urban/suburban sites and 1 rural site using a broad out-of-hospital injury cohort. Specific Aim 2. Evaluate the utility of individual triage criteria (including EMS provider judgment) and re-derive the field trauma triage guidelines within pre-specified age strata for children, adults, and elders. Specific Aim 3. Conduct formal cost analyses of the decision scheme, including differences by hospital type and triage criteria, over- and under-triage, and the cost-effectiveness of different strategies for field triage. Study Design: Population-based, observational, consecutive patient prospective cohort. Setting: The study will be conducted in 3 sites: Portland, OR/Vancouver (4 counties); King County, WA; and Josephine County, OR (rural site). Forty-three EMS agencies and 19 acute care hospitals (3 Level I, 1 Level II, 3 Level III, 4 Level IV, and 8 non-designated community hospitals) will be included. Participants: The study will include all persons with a 9-1-1 response and EMS provider primary impression of "trauma," regardless of whether triage guidelines are met, transport destination or outcome. The EMS cohort will include 58,800 injured patients with 10,877 (the primary sample) sampled for hospital outcomes. Outcome Measures: The primary outcome will be "serious" injury (maximum Abbreviated Injury Scale score 3). The secondary outcome will be a composite measure of serious injury or trauma resource use (major operative intervention, interventional radiology, ICU stay e 2 days, transfusion, prolonged ventilation or in- hospital mortality). Costs will be translated using hospital cost-to-charge ratios, plus EMS and physician costs. PUBLIC HEALTH RELEVANCE: Project Narrative The ability to concentrate seriously injured patients in major trauma centers cost-effectively has significant public health implications. Results of this project will address important knowledge gaps in this public health priority, including: the true age-specific accuracy of field trauma triage guidelines in urban, suburban, and rural community settings; potential changes in the triage algorithm to improve accuracy; and the cost implications of field triage.

描述(由申请人提供)： 建议的方法：院外创伤分诊是创伤系统的关键组成部分，也是将严重创伤患者集中在主要创伤中心的主要机制，但分诊指南从未经过严格验证或进行正式的成本分析。在这个项目中，我们将使用儿童、成人和老年人的预期、基于人群的院外伤害队列来检查现场分诊指南的准确性和成本影响，以及改进分诊算法的机会。重要性：迫切需要数据驱动的解决方案来提高创伤系统的效率、降低成本并保留宝贵的资源，同时仍能最大限度地提高伤害结果。这项研究的结果可能对改善严重受伤患者的成本效益区划具有实质性的影响。目的：本应用程序的总体目标是在广泛的、有代表性的损伤人群中生成对决策方案准确性(敏感性和特异性)的无偏见的年龄特定估计，并密切评估现场分诊的费用影响。我们的假设是，分诊指南的分诊不足和分诊过度的比率比之前认识到的更高，分诊受到EMS提供者判断的严重影响，并且与错误分诊相关的显著成本影响。该建议有3个具体目标：具体目标1.在2个城市/郊区地点和1个农村地点，使用广泛的院外受伤队列，在儿童、成人和老年人中前瞻性地验证现场分诊决策方案。具体目标2.评估个人分诊标准(包括EMS提供者判断)的效用，并在预先指定的年龄层内重新制定针对儿童、成人和老年人的战地创伤分诊指南。具体目标3.对决策方案进行正式费用分析，包括医院类型和分诊标准的差异、分诊过多和分流不足，以及实地分诊不同战略的成本效益。研究设计：以人群为基础，观察性的，连续的患者前瞻性队列。地点：研究将在3个地点进行：俄勒冈州波特兰/温哥华(4个县)；华盛顿州金县；俄勒冈州约瑟芬县(农村县)。将包括43个急救机构和19个急性护理医院(3个一级医院、1个二级医院、3个三级医院、4个四级医院和8个非指定社区医院)。参与者：这项研究将包括所有有9-1-1反应和EMS提供者对“创伤”的主要印象的人，无论是否符合分诊指南，运输目的地或结果。EMS队列将包括58,800名受伤患者，其中10,877人(主要样本)为住院结果抽样。观察指标：主要结果为“严重”损伤(最大缩写损伤评分为3分)。次要结果将是对严重损伤或创伤资源使用(主要手术干预、介入放射学、ICU住院2天、输血、延长机械通气或住院死亡率)的综合衡量。成本将使用医院成本与费用比率加上EMS和医生成本进行换算。 公共卫生相关性： 项目简介将重伤患者集中在主要创伤中心的能力具有成本效益，对公共卫生具有重大影响。该项目的成果将解决这一公共卫生优先事项中的重要知识差距，包括：在城市、郊区和农村社区环境中实地创伤分类指南的具体年龄的真实准确性；分类算法可能发生的变化以提高准确性；以及实地分类所涉费用问题。

项目成果

Emergency medical services responders' perceptions of the effect of stress and anxiety on patient safety in the out-of-hospital emergency care of children: a qualitative study.

• DOI: 10.1136/bmjopen-2016-014057
• 发表时间: 2017-02-28
• 期刊: BMJ open
• 影响因子: 2.9
• 作者: Guise JM;Hansen M;O'Brien K;Dickinson C;Meckler G;Engle P;Lambert W;Jui J
• 通讯作者: Jui J

Deaths and high-risk trauma patients missed by standard trauma data sources.

标准创伤数据源遗漏了死亡和高风险创伤患者。

• DOI: 10.1097/ta.0000000000001616
• 发表时间: 2017
• 期刊: The journal of trauma and acute care surgery
• 作者: Newgard,CraigD;Fu,Rongwei;Lerner,EBrooke;Daya,Mohamud;Wright,Dagan;Jui,Jonathan;Mann,NClay;Bulger,Eileen;Hedges,Jerris;Wittwer,Lynn;Lehrfeld,David;Rea,Thomas
• 通讯作者: Rea,Thomas

Evaluation of Rural vs Urban Trauma Patients Served by 9-1-1 Emergency Medical Services.

• DOI: 10.1001/jamasurg.2016.3329
• 发表时间: 2017-01-01
• 期刊: JAMA surgery
• 影响因子: 16.9
• 作者: Newgard CD;Fu R;Bulger E;Hedges JR;Mann NC;Wright DA;Lehrfeld DP;Shields C;Hoskins G;Warden C;Wittwer L;Cook JN;Verkest M;Conway W;Somerville S;Hansen M
• 通讯作者: Hansen M