PDF(Pubmed)
Abstract：
State guidelines for re-triage, or emergency inter-facility transfer, have never been characterized across the United States.
All 50 states\' Department of Health and/or Trauma System websites were reviewed for publicly available re-triage guidelines within their rules and regulations. Communication was made via phone or email to state agencies or trauma advisory committees to obtain or confirm the absence of guidelines where public data was unavailable. Guideline criteria were abstracted and grouped into domains of Center for Disease Control Field Triage Criteria: pattern/anatomy of injury, vital signs, special populations, and mechanisms of injury. Re-triage criteria were summarized across states using median and interquartile ranges for continuous data and frequencies for categorical data. Demographic data of states with and without re-triage guidelines were compared using the Wilcoxon rank sum test.
Re-triage guidelines were identified for 22 of 50 states (44%). Common anatomy of injury criteria included head trauma (91% of states with guidelines), spinal cord injury (82%), chest injury (77%), and pelvic injury (73%). Common vital signs criteria included Glasgow Coma Score (91% of states) ranging from 8 to 14, systolic blood pressure (36%) ranging from 90 to 100 mm Hg, and respiratory rate (23%) with all using 10 respirations/minute. Common special populations criteria included mechanical ventilation (73% of states), age (68%) ranging from <2 or >60 years, cardiac disease (59%), and pregnancy (55%). No significant demographic differences were found between states with versus without re-triage guidelines.
A minority of US states have re-triage guidelines. Characterizing existing criteria can inform future guideline development.
All 50 states\' Department of Health and/or Trauma System websites were reviewed for publicly available re-triage guidelines within their rules and regulations. Communication was made via phone or email to state agencies or trauma advisory committees to obtain or confirm the absence of guidelines where public data was unavailable. Guideline criteria were abstracted and grouped into domains of Center for Disease Control Field Triage Criteria: pattern/anatomy of injury, vital signs, special populations, and mechanisms of injury. Re-triage criteria were summarized across states using median and interquartile ranges for continuous data and frequencies for categorical data. Demographic data of states with and without re-triage guidelines were compared using the Wilcoxon rank sum test.
Re-triage guidelines were identified for 22 of 50 states (44%). Common anatomy of injury criteria included head trauma (91% of states with guidelines), spinal cord injury (82%), chest injury (77%), and pelvic injury (73%). Common vital signs criteria included Glasgow Coma Score (91% of states) ranging from 8 to 14, systolic blood pressure (36%) ranging from 90 to 100 mm Hg, and respiratory rate (23%) with all using 10 respirations/minute. Common special populations criteria included mechanical ventilation (73% of states), age (68%) ranging from <2 or >60 years, cardiac disease (59%), and pregnancy (55%). No significant demographic differences were found between states with versus without re-triage guidelines.
A minority of US states have re-triage guidelines. Characterizing existing criteria can inform future guideline development.
摘要：
背景：州重新分诊指南，或紧急设施间转移，在美国从未被描述过。
方法：对所有50个州的卫生部和/或创伤系统网站进行了审查，以了解其规章制度中公开提供的重新分诊指南。通过电话或电子邮件与州机构或创伤咨询委员会进行沟通，以获取或确认缺乏公共数据的指南。对指南标准进行了抽象，并将其分为疾病控制中心现场分类标准的领域：损伤的模式/解剖，生命体征,特殊人群,和损伤机制。使用连续数据的中位数和四分位数范围以及分类数据的频率来总结各州的重新分类标准。使用Wilcoxon秩和检验比较了有和没有重新分类指南的州的人口统计数据。
结果：为50个州中的22个州（44%）确定了重新分诊指南。常见的损伤解剖标准包括头部创伤（91％的国家与指南），脊髓损伤（82%），胸部损伤（77%），骨盆损伤（73%）。常见的生命体征标准包括格拉斯哥昏迷评分（91％的州）从8到14，收缩压（36％）从90到100mmHg，和呼吸率（23％），全部使用10次呼吸/分钟。常见的特殊人群标准包括机械通气（73％的州），年龄(68%)在<2岁或>60岁之间，心脏病（59%），怀孕（55%）。在有和没有重新分诊指南的州之间没有发现明显的人口统计学差异。
结论：美国少数州有复诊指南。表征现有标准可以为未来的指南开发提供信息。
方法：对所有50个州的卫生部和/或创伤系统网站进行了审查，以了解其规章制度中公开提供的重新分诊指南。通过电话或电子邮件与州机构或创伤咨询委员会进行沟通，以获取或确认缺乏公共数据的指南。对指南标准进行了抽象，并将其分为疾病控制中心现场分类标准的领域：损伤的模式/解剖，生命体征,特殊人群,和损伤机制。使用连续数据的中位数和四分位数范围以及分类数据的频率来总结各州的重新分类标准。使用Wilcoxon秩和检验比较了有和没有重新分类指南的州的人口统计数据。
结果：为50个州中的22个州（44%）确定了重新分诊指南。常见的损伤解剖标准包括头部创伤（91％的国家与指南），脊髓损伤（82%），胸部损伤（77%），骨盆损伤（73%）。常见的生命体征标准包括格拉斯哥昏迷评分（91％的州）从8到14，收缩压（36％）从90到100mmHg，和呼吸率（23％），全部使用10次呼吸/分钟。常见的特殊人群标准包括机械通气（73％的州），年龄(68%)在<2岁或>60岁之间，心脏病（59%），怀孕（55%）。在有和没有重新分诊指南的州之间没有发现明显的人口统计学差异。
结论：美国少数州有复诊指南。表征现有标准可以为未来的指南开发提供信息。
