PDF(Pubmed)
Abstract：
Many health care systems triage injured patients to major trauma centres (MTCs) or local hospitals by using triage tools and paramedic judgement. Triage tools are typically assessed by whether patients with an Injury Severity Score (ISS) ≥ 16 go to an MTC and whether patients with an ISS < 16 are sent to their local hospital. There is a trade-off between sensitivity and specificity of triage tools, with the optimal balance being unknown. We conducted an economic evaluation of major trauma triage tools to identify which tool would be considered cost-effective by UK decision makers.
A patient-level, probabilistic, mathematical model of a UK major trauma system was developed. Patients with an ISS ≥ 16 who were only treated at local hospitals had worse outcomes compared to being treated in an MTC. Nine empirically derived triage tools, from a previous study, were examined so we assessed triage tools with realistic trade-offs between triage tool sensitivity and specificity. Lifetime costs, lifetime quality adjusted life years (QALYs), and incremental cost-effectiveness ratios (ICERs) were calculated for each tool and compared to maximum acceptable ICERs (MAICERs) in England.
Four tools had ICERs within the normal range of MAICERs used by English decision makers (£20,000 to £30,000 per QALY gained). A low sensitivity (28.4%) and high specificity (88.6%) would be cost-effective at the lower end of this range while higher sensitivity (87.5%) and lower specificity (62.8%) was cost-effective towards the upper end of this range. These results were sensitive to the cost of MTC admissions and whether MTCs had a benefit for patients with an ISS between 9 and 15.
The cost-effective triage tool depends on the English decision maker\'s MAICER for this health problem. In the usual range of MAICERs, cost-effective prehospital trauma triage involves clinically suboptimal sensitivity, with a proportion of seriously injured patients (at least 10%) being initially transported to local hospitals. High sensitivity trauma triage requires development of more accurate decision rules; research to establish if patients with an ISS between 9 and 15 benefit from MTCs; or, inefficient use of health care resources to manage patients with less serious injuries at MTCs.
A patient-level, probabilistic, mathematical model of a UK major trauma system was developed. Patients with an ISS ≥ 16 who were only treated at local hospitals had worse outcomes compared to being treated in an MTC. Nine empirically derived triage tools, from a previous study, were examined so we assessed triage tools with realistic trade-offs between triage tool sensitivity and specificity. Lifetime costs, lifetime quality adjusted life years (QALYs), and incremental cost-effectiveness ratios (ICERs) were calculated for each tool and compared to maximum acceptable ICERs (MAICERs) in England.
Four tools had ICERs within the normal range of MAICERs used by English decision makers (£20,000 to £30,000 per QALY gained). A low sensitivity (28.4%) and high specificity (88.6%) would be cost-effective at the lower end of this range while higher sensitivity (87.5%) and lower specificity (62.8%) was cost-effective towards the upper end of this range. These results were sensitive to the cost of MTC admissions and whether MTCs had a benefit for patients with an ISS between 9 and 15.
The cost-effective triage tool depends on the English decision maker\'s MAICER for this health problem. In the usual range of MAICERs, cost-effective prehospital trauma triage involves clinically suboptimal sensitivity, with a proportion of seriously injured patients (at least 10%) being initially transported to local hospitals. High sensitivity trauma triage requires development of more accurate decision rules; research to establish if patients with an ISS between 9 and 15 benefit from MTCs; or, inefficient use of health care resources to manage patients with less serious injuries at MTCs.
摘要：
许多医疗保健系统通过使用分诊工具和护理人员判断，将受伤的患者分诊到主要创伤中心（MTC）或当地医院。通常通过损伤严重度评分(ISS)≥16的患者是否去MTC以及ISS<16的患者是否被送往当地医院来评估分诊工具。分诊工具的敏感性和特异性之间存在权衡，最佳平衡是未知的。我们对主要创伤分诊工具进行了经济评估，以确定英国决策者认为哪种工具具有成本效益。
患者级别,概率，建立了英国主要创伤系统的数学模型。仅在当地医院接受治疗的ISS≥16的患者与在MTC中接受治疗相比具有更差的结果。九种经验衍生的分诊工具，从以前的研究来看，进行了检查，因此我们评估了分诊工具，在分诊工具灵敏度和特异性之间进行了现实的权衡。终身成本,终身质量调整寿命年(QALYs)，计算每个工具的增量成本效益比(ICER),并与英格兰的最大可接受ICER(MAICER)进行比较.
四种工具的ICER在英国决策者使用的MAICER的正常范围内（每QALY获得20,000至30,000英镑）。低灵敏度(28.4%)和高特异性(88.6%)在该范围的下端将是成本有效的,而更高的灵敏度(87.5%)和更低的特异性(62.8%)在该范围的上端是成本有效的。这些结果对MTC入院的成本以及MTC是否对9至15岁的ISS患者有益处敏感。
经济有效的分诊工具取决于英国决策者的MAICER来解决这个健康问题。在通常的MAICER范围内，具有成本效益的院前创伤分诊涉及临床上次优的敏感性，部分严重受伤的患者（至少10％）最初被送往当地医院。高灵敏度的创伤分诊需要制定更准确的决策规则；研究以确定ISS在9到15之间的患者是否受益于MTC；或者，低效使用医疗保健资源来管理在MTC中受伤较少的患者。
患者级别,概率，建立了英国主要创伤系统的数学模型。仅在当地医院接受治疗的ISS≥16的患者与在MTC中接受治疗相比具有更差的结果。九种经验衍生的分诊工具，从以前的研究来看，进行了检查，因此我们评估了分诊工具，在分诊工具灵敏度和特异性之间进行了现实的权衡。终身成本,终身质量调整寿命年(QALYs)，计算每个工具的增量成本效益比(ICER),并与英格兰的最大可接受ICER(MAICER)进行比较.
四种工具的ICER在英国决策者使用的MAICER的正常范围内（每QALY获得20,000至30,000英镑）。低灵敏度(28.4%)和高特异性(88.6%)在该范围的下端将是成本有效的,而更高的灵敏度(87.5%)和更低的特异性(62.8%)在该范围的上端是成本有效的。这些结果对MTC入院的成本以及MTC是否对9至15岁的ISS患者有益处敏感。
经济有效的分诊工具取决于英国决策者的MAICER来解决这个健康问题。在通常的MAICER范围内，具有成本效益的院前创伤分诊涉及临床上次优的敏感性，部分严重受伤的患者（至少10％）最初被送往当地医院。高灵敏度的创伤分诊需要制定更准确的决策规则；研究以确定ISS在9到15之间的患者是否受益于MTC；或者，低效使用医疗保健资源来管理在MTC中受伤较少的患者。
