PDF(Pubmed)
Abstract：
BACKGROUND: Care for injured patients in England is provided by inclusive regional trauma networks. Ambulance services use triage tools to identify patients with major trauma who would benefit from expedited Major Trauma Centre (MTC) care. However, there has been no investigation of triage performance, despite its role in ensuring effective and efficient MTC care. This study aimed to investigate the accuracy of prehospital major trauma triage in representative English trauma networks.
METHODS: A diagnostic case-cohort study was performed between November 2019 and February 2020 in 4 English regional trauma networks as part of the Major Trauma Triage Study (MATTS). Consecutive patients with acute injury presenting to participating ambulance services were included, together with all reference standard positive cases, and matched to data from the English national major trauma database. The index test was prehospital provider triage decision making, with a positive result defined as patient transport with a pre-alert call to the MTC. The primary reference standard was a consensus definition of serious injury that would benefit from expedited major trauma centre care. Secondary analyses explored different reference standards and compared theoretical triage tool accuracy to real-life triage decisions.
RESULTS: The complete-case case-cohort sample consisted of 2,757 patients, including 959 primary reference standard positive patients. The prevalence of major trauma meeting the primary reference standard definition was 3.1% (n=54/1,722, 95% CI 2.3 - 4.0). Observed prehospital provider triage decisions demonstrated overall sensitivity of 46.7% (n=446/959, 95% CI 43.5-49.9) and specificity of 94.5% (n=1,703/1,798, 95% CI 93.4-95.6) for the primary reference standard. There was a clear trend of decreasing sensitivity and increasing specificity from younger to older age groups. Prehospital provider triage decisions commonly differed from the theoretical triage tool result, with ambulance service clinician judgement resulting in higher specificity.
CONCLUSIONS: Prehospital decision making for injured patients in English trauma networks demonstrated high specificity and low sensitivity, consistent with the targets for cost-effective triage defined in previous economic evaluations. Actual triage decisions differed from theoretical triage tool results, with a decreasing sensitivity and increasing specificity from younger to older ages.
METHODS: A diagnostic case-cohort study was performed between November 2019 and February 2020 in 4 English regional trauma networks as part of the Major Trauma Triage Study (MATTS). Consecutive patients with acute injury presenting to participating ambulance services were included, together with all reference standard positive cases, and matched to data from the English national major trauma database. The index test was prehospital provider triage decision making, with a positive result defined as patient transport with a pre-alert call to the MTC. The primary reference standard was a consensus definition of serious injury that would benefit from expedited major trauma centre care. Secondary analyses explored different reference standards and compared theoretical triage tool accuracy to real-life triage decisions.
RESULTS: The complete-case case-cohort sample consisted of 2,757 patients, including 959 primary reference standard positive patients. The prevalence of major trauma meeting the primary reference standard definition was 3.1% (n=54/1,722, 95% CI 2.3 - 4.0). Observed prehospital provider triage decisions demonstrated overall sensitivity of 46.7% (n=446/959, 95% CI 43.5-49.9) and specificity of 94.5% (n=1,703/1,798, 95% CI 93.4-95.6) for the primary reference standard. There was a clear trend of decreasing sensitivity and increasing specificity from younger to older age groups. Prehospital provider triage decisions commonly differed from the theoretical triage tool result, with ambulance service clinician judgement resulting in higher specificity.
CONCLUSIONS: Prehospital decision making for injured patients in English trauma networks demonstrated high specificity and low sensitivity, consistent with the targets for cost-effective triage defined in previous economic evaluations. Actual triage decisions differed from theoretical triage tool results, with a decreasing sensitivity and increasing specificity from younger to older ages.
摘要：
背景：英格兰受伤患者的护理是由包容性区域创伤网络提供的。救护车服务使用分诊工具来识别患有重大创伤的患者，这些患者将从快速的重大创伤中心（MTC）护理中受益。然而,没有对分诊性能进行调查，尽管它在确保有效和高效的MTC护理方面发挥了作用。本研究旨在调查代表性英国创伤网络中院前重大创伤分诊的准确性。
方法：在2019年11月至2020年2月期间，在4个英国区域性创伤网络中进行了一项诊断性病例队列研究，作为主要创伤分类研究（MATTS）的一部分。连续出现急性损伤的患者出现在参与的救护车服务中，连同所有参考标准阳性病例，并与英国国家重大创伤数据库中的数据相匹配。指标测试是院前提供者分诊决策，将阳性结果定义为患者运输并向MTC发出预警呼叫。主要参考标准是对严重伤害的共识定义，该定义将受益于快速的重大创伤中心护理。二次分析探索了不同的参考标准，并将理论分诊工具的准确性与现实生活中的分诊决策进行了比较。
结果：完整病例队列样本包括2,757名患者，包括959名主要参考标准阳性患者。符合主要参考标准定义的重大创伤的患病率为3.1％（n=54/1,722，95％CI2.3-4.0）。观察到的院前提供者分诊决定显示，主要参考标准的总体敏感性为46.7％（n=446/959，95％CI43.5-49.9）和特异性为94.5％（n=1,703/1,798，95％CI93.4-95.6）。从年轻到老年组有明显的敏感性下降和特异性增加的趋势。院前提供者分诊决策通常与理论分诊工具结果不同，与救护车服务临床医生的判断导致更高的特异性。
结论：英国创伤网络中受伤患者的院前决策表现出高特异性和低敏感性，与以前的经济评估中定义的具有成本效益的分诊目标一致。实际分诊决策与理论分诊工具结果不同，从年轻到老年，敏感性降低，特异性增加。
方法：在2019年11月至2020年2月期间，在4个英国区域性创伤网络中进行了一项诊断性病例队列研究，作为主要创伤分类研究（MATTS）的一部分。连续出现急性损伤的患者出现在参与的救护车服务中，连同所有参考标准阳性病例，并与英国国家重大创伤数据库中的数据相匹配。指标测试是院前提供者分诊决策，将阳性结果定义为患者运输并向MTC发出预警呼叫。主要参考标准是对严重伤害的共识定义，该定义将受益于快速的重大创伤中心护理。二次分析探索了不同的参考标准，并将理论分诊工具的准确性与现实生活中的分诊决策进行了比较。
结果：完整病例队列样本包括2,757名患者，包括959名主要参考标准阳性患者。符合主要参考标准定义的重大创伤的患病率为3.1％（n=54/1,722，95％CI2.3-4.0）。观察到的院前提供者分诊决定显示，主要参考标准的总体敏感性为46.7％（n=446/959，95％CI43.5-49.9）和特异性为94.5％（n=1,703/1,798，95％CI93.4-95.6）。从年轻到老年组有明显的敏感性下降和特异性增加的趋势。院前提供者分诊决策通常与理论分诊工具结果不同，与救护车服务临床医生的判断导致更高的特异性。
结论：英国创伤网络中受伤患者的院前决策表现出高特异性和低敏感性，与以前的经济评估中定义的具有成本效益的分诊目标一致。实际分诊决策与理论分诊工具结果不同，从年轻到老年，敏感性降低，特异性增加。
