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首页> 外文期刊>European journal of trauma and emergency surgery: official publication of the European Trauma Society >Prehospital triage for mass casualty incidents using the META method for early surgical assessment: retrospective validation of a hospital trauma registry
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Prehospital triage for mass casualty incidents using the META method for early surgical assessment: retrospective validation of a hospital trauma registry

机译：使用META方法进行早期手术评估的群众伤亡事故的预播种分类：医院创伤登记处的回顾性验证

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Background In mass casualty incidents (MCI), death usually occurs within the first few hours and thus early transfer to a trauma centre can be crucial in selected cases. However, most triage systems designed to prioritize the transfer to hospital of these patients do not assess the need for surgery, in part due to inconclusive evidence regarding the value of such an assessment. Therefore, the aim of the present study was to evaluate the capacity of a new triage system-the Prehospital Advanced Triage Method (META)-to identify victims who could benefit from urgent surgical assessment in case of MCI. Methods Retrospective, descriptive, observational study of a multipurpose cohort of patients included in the severe trauma registry of the Gregorio Maranon University General Hospital (Spain) between June 1993 and December 2011. All data were prospectively evaluated. All patients were evaluated with the META system to determine whether they met the criteria for urgent transfer. The META defines patients in need of urgent surgical assessment: (a) All penetrating injuries to head, neck, torso and extremities proximal to elbow or knee, (b) Open pelvic fracture, (c) Closed pelvic fracture with mechanical or haemodynamic instability and (d) Blunt torso trauma with haemodynamic instability. Patients who fulfilled these criteria were designated as "Urgent Evacuation for Surgical Assessment" (UESA) cases; all other cases were designated as non-UESA. The following variables were assessed: patient status at the scene; severity scales [RTS, Shock index, MGAP (Mechanism, Glasgow coma scale, Age, pressure), GCS]; need for surgery and/or interventional procedure to control bleeding (UESA); and mortality. The two groups (UESA vs. non-UESA) were then compared. Results A total of 1882 cases from the database were included in the study. Mean age was 39.2 years and most (77%) patients were male. UESA patients presented significantly worse on-scene hemodynamic parameters (systolic blood pressure and heart rate) and greater injury severity (RTS, shock index, and MGAP scales). No differences were observed for respiratory rate, need for orotracheal intubation, or GCS scores. The anatomical injuries of patients in the UESA group were less severe but these patients had a greater need for urgent surgery and higher mortality rates. Conclusion These findings suggest that the META triage classification system could be beneficial to help identify patients with severe trauma and/or in need of urgent surgical assessment at the scene of injury in case of MCI. These findings demonstrate that, in this cohort, the META fulfils the purpose for which it was designed.
机译：背景技术在大规模伤亡事件（MCI）中，死亡通常发生在最初的几个小时内，因此在选定病例中早期转移至创伤中心可能是至关重要的。然而，大多数旨在优先考虑到这些患者的医院的大多数分类系统都没有评估手术的需求，部分原因是关于这种评估价值的不确定证据。因此，本研究的目的是评估新的分类系统 - 预孢子的先进分类方法（META） - 识别可能在MCI的紧急外科评估中受益的受害者。方法1993年6月至2011年12月在Gregorio Maranon大学综合医院（Spain）严重创伤患者中携带的患者的多功能队列患者的回顾性，描述性，观察研究。所有患者都被元系统评估，以确定他们是否符合紧急转移的标准。 Meta定义了需要紧急外科评估的患者：（a）所有对肘部或膝关节近端的头部，颈部，躯干和四肢损伤，（b）打开盆腔骨折，（c）闭合骨盆骨折，具有机械或血管动力学不稳定和（d）钝性躯干创伤，具有血管动力学不稳定。满足这些标准的患者被指定为“手术评估的紧急疏散”（UESA）案件;所有其他案件都被指定为非UESA。评估以下变量：现场的患者状态;严重程度尺度[RTS，冲击指数，MGAP（机制，GLASGOW COMA规模，年龄，压力），GCS];需要手术和/或介入程序来控制出血（UESA）;和死亡率。然后比较两组（UESA与非UESA）。结果在研究中共有1882例案例。平均年龄为39.2岁，大多数（77％）患者是男性。尤塞萨患者呈现出显着差的场景血液动力学参数（收缩压和心率）和更大的伤害严重程度（RTS，休克指数和MGAP尺度）。对于呼吸速率没有观察到差异，需要对orotcracheal插管或GCS分数进行。 UESA组患者的解剖学损伤不太严重，但这些患者对紧急手术和更高的死亡率进行了更高的需求。结论这些研究结果表明，元分类分类系统可能有益，可以帮助鉴定严重创伤的患者和/或需要在MCI的伤害现场进行紧急手术评估。这些调查结果表明，在这队队列中，元满足了它所设计的目的。

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