외상 환자를 위한 변형된 중증 외상 팀 활성화 기준의 적절성 평가 (The Appropriateness of Modified Trauma Team Activation Protocol for Trauma Patients in Emergency Department)

서지정보

· 발행기관 : 대한응급의학회
· 수록지 정보 : 대한응급의학회지 / 26권 / 1호 / 15 ~ 20페이지
· 저자명 : 황지현, 최승필, 위정희, 박정호, 차경만

초록

Purpose: Rapid multidisciplinary trauma care by trauma team is essential for severely injured patients. Different protocols for trauma team activation are used in each hospital.
Correct trauma triage is needed to ensure appropriate use of medical resources. The aim of this study was to evaluate the performance of our modified protocol for trauma team activation.
Methods: This is an observational, retrospective cohort study. Injured patients with trauma team activation (TTA) or who had been admitted to a surgical intensive care unit were investigated from 1st March 2010 to 31st May 2012.
The TTA protocol was analyzed with respect to sensitivity, positive predictive value (PPV), and overtriage (1-PPV).
Undertriage (1-sensitivity) was defined as no TTA despite severe injury (Injury Severity Score (ISS) >15).
Results: A total of 229 patients were included. There were 201 patients with TTA and 28 patients without TTA. Of the 201 patients with TTA, 104 were identified as severely injured (ISS>15), yielding sensitivity of 79%, PPV of 51%, and overtriage of 49%. Undertriage was 21% (n=28) when considering all severely injured patients (n=132). Among 12 criteria of our TTA protocol, ‘injury in two or more body regions’ accounted for 85.6% of the overtriage. Of the patients with undertriage, 75% represented isolated head injury and 28.5% from interhospital transfer.
Conclusion: The rate of overtriage of TTA protocol in our hospital is appropriate, but the rate of undertriage is relatively high. We believe, to decrease the overtriage of all and undertriage in patients with injury in an isolated specific body region, more research for evaluation of effects of protocol excluding the criteria of ‘injury in two or more body regions’ is needed.

영어초록

Purpose: Rapid multidisciplinary trauma care by trauma team is essential for severely injured patients. Different protocols for trauma team activation are used in each hospital.
Correct trauma triage is needed to ensure appropriate use of medical resources. The aim of this study was to evaluate the performance of our modified protocol for trauma team activation.
Methods: This is an observational, retrospective cohort study. Injured patients with trauma team activation (TTA) or who had been admitted to a surgical intensive care unit were investigated from 1st March 2010 to 31st May 2012.
The TTA protocol was analyzed with respect to sensitivity, positive predictive value (PPV), and overtriage (1-PPV).
Undertriage (1-sensitivity) was defined as no TTA despite severe injury (Injury Severity Score (ISS) >15).
Results: A total of 229 patients were included. There were 201 patients with TTA and 28 patients without TTA. Of the 201 patients with TTA, 104 were identified as severely injured (ISS>15), yielding sensitivity of 79%, PPV of 51%, and overtriage of 49%. Undertriage was 21% (n=28) when considering all severely injured patients (n=132). Among 12 criteria of our TTA protocol, ‘injury in two or more body regions’ accounted for 85.6% of the overtriage. Of the patients with undertriage, 75% represented isolated head injury and 28.5% from interhospital transfer.
Conclusion: The rate of overtriage of TTA protocol in our hospital is appropriate, but the rate of undertriage is relatively high. We believe, to decrease the overtriage of all and undertriage in patients with injury in an isolated specific body region, more research for evaluation of effects of protocol excluding the criteria of ‘injury in two or more body regions’ is needed.

참고자료

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