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首页> 外文期刊>Prehospital emergency care >Role of Guideline Adherence in Improving Field Triage
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Role of Guideline Adherence in Improving Field Triage

机译：准则遵守在改善现场分类中的作用

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摘要

Objective: To compare the sensitivity of current field triage practices for identifying high-risk trauma patients to strict guideline adherence, including changes in triage specificity, ambulance transport patterns, and trauma center volumes. Methods: This was a pre-planned secondary analysis of an out-of-hospital prospective cohort of injured children and adults transported by 44 EMS agencies to 28 trauma and non-trauma hospitals in 7 Northwest U.S. counties from January 1, 2011 through December 31, 2011. Outcomes included Injury Severity Score (ISS) 16 (primary) and early critical resource use. Strict adherence of the triage guidelines was based on evidence in the EMS chart for patients meeting any current field triage criteria, calculated with and without strict interpretation of the age criterion (<15 or >55years). Due to the probability sampling nature of the cohort, strata and weights were included in all analyses. Results: 17,633 injured patients were transported by EMS (weighted to represent 53,487 transported patients), including 3.1% with ISS 16 and 1.7% requiring early critical resources. Field triage sensitivity for identifying patients with ISS 16 increased from the current 66.2% (95% CI 60.2-71.7%) to 87.3% (95% CI 81.9-91.2%) for strict adherence without age and to 91.0% (95% CI 86.4-94.2%) for strict adherence with age. Specificity decreased with increasing adherence, from 87.8% (current) to 47.6% (strict adherence without age) and 35.8% (strict adherence with age). Areas under the curve (AUC) were 0.78, 0.73, and 0.72, respectively. Results were similar for patients requiring early critical resources. We estimate the number of triage-positive patients transported each year by EMS to an individual major trauma center (on average) to increase from 1,331 (current) to 5,139 (strict adherence without age) and to 6,256 (strict adherence with age). Conclusions: The low sensitivity of current triage practices would be expected to improve with strict adherence to current triage guidelines, with a commensurate decrease in triage specificity and an increase in the number of triage-positive patients transported to major trauma centers.
机译：目的：比较鉴定高危创伤患者的当前现场分类实践的敏感性，以严格指导遵守，包括分类特异性，救护车运输模式和创伤中心卷的变化。方法：这是2011年12月1日至12月1日至12月1日至12月31日，在2011年1月1日至12月31日在2011年12月1日至12月31日的7月7日县的24个EMS机构向28个创伤和非创伤医院运送的医院预期妇女和成人的预先培养的次要分析，2011。结果包括伤害严重程度（ISS）16（初级）和早期关键资源使用。严格遵守分类指南是基于EMS图表中的证据，以满足任何当前现场分类标准的患者，并没有严格地解释年龄标准（<15或55年）。由于群组的概率采样性质，所有分析中都包含群体和体重。结果：17,633名受伤患者被EMS运输（加权，占运输53,487名患者），其中有3.1％，ISS 16和1.7％需要早期关键资源。用于鉴定ISS 16患者的场分类敏感性从目前的66.2％（95％CI 60.2-71.7％）增加到87.3％（95％CI 81.9-91.2％），用于严格粘附，毫不衰竭和91.0％（95％CI 86.4 -94.2％）严格遵守年龄。特异性随着依从性的增加而减少，从87.8％（当前）到47.6％（严格依赖于年龄）和35.8％（严格遵守年龄）。曲线（AUC）下的区域分别为0.78,0.73和0.72。结果对于需要早期关键资源的患者类似。我们估计EMS每年运输的分类阳性患者的数量与个体重大创伤中心（平均）从1,331（当前）增加到5,139（严格依赖于年龄）和6,256（严格遵守年龄）。结论：预计当前分类实践的低敏感性将严格遵守当前的分类指南，分类特异性的相称性降低，分类阳性患者的数量增加，分类为主要创伤中心。

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  • 来源
    《Prehospital emergency care》 |2017年第5期|共11页
  • 作者

    Newgard Craig D.; Fu Rongwei; Lerner E. Brooke; Daya Mohamud; Jui Jonathan; Wittwer Lynn; Schmidt Terri A.; Zive Dana; Bulger Eileen M.; Sahni Ritu; Warden Craig; Kuppermann Nathan;

  • 作者单位

    Oregon Hlth &

    Sci Univ Emergency Med 3181 SW Sam Jackson Pk Rd Mailcode CR-114 Portland OR;

    Oregon Hlth &

    Sci Univ Emergency Med 3181 SW Sam Jackson Pk Rd Mailcode CR-114 Portland OR;

    Med Coll Wisconsin Emergency Med Milwaukee WI 53226 USA;

    Oregon Hlth &

    Sci Univ Emergency Med 3181 SW Sam Jackson Pk Rd Mailcode CR-114 Portland OR;

    Oregon Hlth &

    Sci Univ Emergency Med 3181 SW Sam Jackson Pk Rd Mailcode CR-114 Portland OR;

    Clark Cty Emergency Med Serv Vancouver WA USA;

    Oregon Hlth &

    Sci Univ Emergency Med 3181 SW Sam Jackson Pk Rd Mailcode CR-114 Portland OR;

    Oregon Hlth &

    Sci Univ Emergency Med 3181 SW Sam Jackson Pk Rd Mailcode CR-114 Portland OR;

    Harborview Med Ctr Trauma Surg Seattle WA USA;

    Providence Portland Med Ctr Portland OR USA;

    Oregon Hlth &

    Sci Univ Emergency Med 3181 SW Sam Jackson Pk Rd Mailcode CR-114 Portland OR;

    Univ Calif Davis Emergency Med Sacramento CA 95817 USA;

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  • 原文格式 PDF
  • 正文语种 eng
  • 中图分类 护理学;
  • 关键词

    emergency medical services; triage; trauma; adherence;

    机译：紧急医疗服务;分类;创伤;坚持;

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