■重大创伤中心(MTC)护理与改善受伤患者的预后有关。英国的救护车服务和创伤网络目前使用一系列分诊工具来选择患者旁路到MTC。标准化的国家分诊工具可以提高分诊准确性,成本效益和决策的可重复性。
■我们进行了专家共识过程,以得出和开发一种主要的创伤分类工具,用于英国创伤网络。进行了基于网络的Delphi调查,以识别和确认主要创伤的候选分诊工具预测因子。召开了促进圆桌共识会议,以确认拟议的分类工具的目的,目标诊断阈值,范围,预期的人口和结构,以及个人分诊工具的预测因子和切点。举行了公众和患者参与(PPI)焦点小组,以确保分诊工具对服务用户的可接受性。
■Delphi调查就两个领域的9个分类变量达成共识,三轮后,从109个候选变量中提取。在协商一致会议期间对相关证据进行审查后,反复的讨论在分诊工具的以下方面达成了共识:参考标准,范围,目标诊断准确性和预期人群。包括生理学的三步工具,解剖损伤和临床判断领域,平行评估分诊变量,被推荐。分诊工具受到PPI焦点小组的好评。
■本文提出了一种新的专家共识得出的主要创伤分诊工具,具有明确的目的,范围,预期人口,结构,组成变量,变量定义和阈值。需要进行前瞻性评估以确定临床和成本效益,可接受性和可用性。
UNASSIGNED: Major trauma centre (MTC) care has been associated with improved outcomes for injured patients. English ambulance services and trauma networks currently use a range of triage tools to select patients for bypass to MTCs. A standardised national triage tool may improve triage accuracy, cost-effectiveness and the reproducibility of decision-making.
UNASSIGNED: We conducted an expert consensus process to derive and develop a major trauma triage tool for use in English trauma networks. A web-based Delphi survey was conducted to identify and confirm candidate triage tool predictors of major trauma. Facilitated roundtable consensus meetings were convened to confirm the proposed triage tool\'s purpose, target diagnostic threshold, scope, intended population and structure, as well as the individual triage tool predictors and cut points. Public and patient involvement (PPI) focus groups were held to ensure triage tool acceptability to service users.
UNASSIGNED: The Delphi survey reached consensus on nine triage variables in two domains, from 109 candidate variables after three rounds. Following a review of the relevant evidence during the consensus meetings, iterative rounds of discussion achieved consensus on the following aspects of the triage tool: reference standard, scope, target diagnostic accuracy and intended population. A three-step tool comprising physiology, anatomical injury and clinical judgement domains, with triage variables assessed in parallel, was recommended. The triage tool was received favourably by PPI focus groups.
UNASSIGNED: This paper presents a new expert consensus derived major trauma triage tool with defined purpose, scope, intended population, structure, constituent variables, variable definitions and thresholds. Prospective evaluation is required to determine clinical and cost-effectiveness, acceptability and usability.